2003 Maryland Magazine by University of Maryland, Baltimore

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MARYLAND r e s e a r c h

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s c h o l a r s h i p

2003

It takes a

Village

Conjoined twins from Africa are separated by a talented team of health professionals.

Dr. Cindy Howard with twins Loice and Christine Onziga

f o r a l u m n i & f r i e n d s o f t h e d e n ta l , g r a d uat e , l aw, m e d i c a l , n u r s i n g , p h a r m a c y, a n d s o c i a l w o r k s c h o o l s

P R E S I D E N T’S

MESSAGE

A Bright Future

UNIVERSITY

MARYLAND

/ 2003

IT HAS BEEN A DIFFICULT YEAR FOR OUR STATE AND NATION. THE TRULY HORRIFIC EVENTS OF SEPTEMBER 11, 2001, THE ANTHRAX EPISODE, THE SMALLPOX SCARE, THE FALTERING ECONOMY, THE ACTS OF TERRORISM HERE AND ABROAD,

and the knowledge that our nation may be poised on the edge of war have all contributed to a loss of innocence, a malaise that can seem overwhelming at times. And yet, as I look at the University of Maryland, Baltimore campus, I am extraordinarily proud of what we have achieved and remain enthusiastic about the future. Last fiscal year, our faculty received more than $305 million in externally sponsored research contracts and grants, a record that has more than doubled in five years, and is approximately twice what we receive from the state of Maryland in operating fund support. Our medical school now ranks ninth among public medical schools and 17th overall in total research funding. The Dental School is sixth in the country in funding from the National Institutes of Health (NIH). When we couple our external research funding with clinical revenue from patient care, tuition and fees, and philanthropic support, state revenue shrinks to only about a quarter of our operating budget. We are truly an economic engine for the Baltimore metropolitan region, the state, and the nation, generating all told nearly $12 in economic activity for every $1 of state investment. But the numbers by themselves tell only a small part of the story. What is so gratifying is that the knowledge being created here has the potential to truly transform lives. Recognized nationally as second only to Harvard in quality, our law school’s Law and Health Care Program has provided invaluable assistance to Maryland’s fight against tobacco use by helping municipalities construct and enforce laws against selling tobacco products to minors. From the groundbreaking studies on schizophrenia at the Maryland Psychiatric Research Center to the research on infectious disease and pathogens at the internationally renowned Center for Vaccine Development, to the discoveries being made at the Greenebaum Cancer Center and the life-saving procedures performed by surgeons from our School of Medicine, our faculty are finding answers to some of the most challenging problems that face our society today. Our schools of dentistry, law, medicine, nursing, pharmacy, and social work are striving to help individuals and communities receive vital health care services throughout the region. By addressing barriers, such as high prescription costs, workforce shortages, and discrimination, University professionals are providing solutions to the growing problem of poor access to care.

David J. Ramsay

It is because of the quality and responsiveness of our schools and programs that we were able to recruit two outstanding educators: Dr. Janet Allan and Dr. Christian Stohler, who serve, respectively, as dean of the University of Maryland School of Nursing and dean of the Baltimore College of Dental Surgery/Dental School. Dean Allan, who comes to us after serving as dean of the School of Nursing, University of Texas Health Sciences Center in San Antonio, has an outstanding record in research and scholarship. She has received more than $3 million in research support and authored or co-authored more Janet Allan than 75 books and articles. She currently serves on the board of the American Academy of Nursing and as the vice chair of the U.S. Preventive Services Task Force. Dean Stohler, a prosthodontist who served most recently as endowed professor and chair of the Department of Biologic and Materials Sciences at the Christian Stohler University of Michigan Dental School, has an international reputation for research on pain and for curricular innovation in dental education. Dr. Stohler currently has more than $1.4 million in research support from the NIH and serves on the NIH National Institute of Dental and Craniofacial Research Board of Scientific Counselors. I invite you to join me in welcoming our new deans and in being proud of the state’s academic health, human services, and law center—the University of Maryland.

DAVID J. RAMSAY, DM, DPHIL PRESIDENT

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COVER STORY

MIRACLE OF 22 THE MODERN MEDICINE Health Professionals Separate Twins Conjoined twins from Africa travel to the University of Maryland for a successful operation performed by a 35-member team.

FEATU RES

CHANCE MEETING LEADS TO COLLABORATIVE CANCER RESEARCH Researchers from the schools of pharmacy and medicine combine efforts to develop breakthroughs in cancer treatment.

4 THE GENETICS OF LONGEVITY Scientists look to Old Order Amish for the secret to long life.

MICHAEL GREENBERGER LEADS CENTER FOR HEALTH AND HOMELAND SECURITY Center pools University expertise to address threats posed by terrorism.

FELLOWS BRING CARE 36 DENTAL TO THE NEEDY A Dental School fellowship program provides care to low-income Marylanders.

BROADENS RESEARCH 42 GCRC ACCESS FOR INVESTIGATORS The General Clinical Research Center helps expand science research to create life-saving drugs, devices, and therapies.

HINDERS 49 DISCRIMINATION HEALTH CARE ACCESS School of Law professor looks to legal solutions to make health care more accessible.

ACCESS TO CARE

WELLMOBILE BRINGS HEALTH CARE TO THE UNDERSERVED

DEPARTMENTS

The School of Nursing’s mobile clinic takes health care on the road.

WORK IS GOOD MEDICINE 30 SOCIAL FOR CANCER SURVIVORS

Research from the School of Social Work highlights the importance of social work counseling for cancer patients.

52 FOUNDERS WEEK 54 UNIVERSITY LEADERSHIP

RX SAVINGS FOR SENIORS

56 RESEARCH ACTIVITIES & GRANTS

The School of Pharmacy’s Peter Lamy Center for Drug Therapy and Aging helps seniors get affordable

Chance Meeting Leads to Collaborative Sorbitol Research School of Pharmacy and School of Medicine researchers’ work may lead to cancer breakthroughs. BY RANDOLPH FILLMORE

WORKING WITH BERRIES FROM THE MOUNTAIN ASH TREE, FRENCH CHEMIST JEANBAPTISTE BOUSSINGAULT IN 1868 ISOLATED AND NAMED SORBITOL—A FORM OF NATURAL SWEETENER—PRESENT AT HIGH LEVELS IN THE MOUNTAIN ASH. SORBITOL

is highly concentrated in the white ash’s berries. Boussingault knew right away that sorbitol was interesting. Sorbitol is sweet, and it’s found naturally in a wide range of fruits and plants. Sorbitol is also produced naturally in the body, and it is a compound that allows mammals and insects to hibernate safely through the winter. For those with diabetes, elevated levels of sorbitol can accelerate nerve damage. Some sufferers of mood disorders have been reported to have elevated sorbitol levels in their spinal fluid. Sorbitol is used commercially in foods as a non-sugar sweetener and in over-the-counter liquid medications. Too much sorbitol can cause gastric distress for some. It is also a laxative. If Paul Shapiro, PhD, an assistant professor in the University of Maryland School of Pharmacy, is correct, sorbitol may also hold a secret for helping in the fight against cancer. “We have set out to discover whether an increase in the activity of aldose reductase, the enzyme that converts glucose into sorbitol, may serve a protective function for cancer cells,” says Shapiro. “We found that a drug that inhibits aldose reductase appears to enhance the activity of chemotherapy drugs that kill cancer cells. This means that if this substance enhances the work of chemotherapy drugs, less of the drugs may be needed. This would benefit patients because the side effects of chemotherapy are often as bad as or worse than the disease.” Shapiro’s interest in sorbitol and its possible role in chemotherapy and cancer came about after a chance meeting with William Regenold, MD, an assistant professor in the Department of Psychiatry at the University of Maryland School of Medicine. The two scientists met while commuting to the University on the Maryland Transit Authority’s Light Rail. On their way to work, the two researchers struck up a conversation and found that they shared an interest in protein function. Regenold told Shapiro that he was examining the role of excess sorbitol in the spinal fluid of patients who suffered from mood disorders, such as bipolar disorder. He mentioned that high levels of sorbitol have been repeatedly associated with the development of diabetic neuropathy—a form of nerve damage frequently suffered by patients with diabetes. “I had been looking at the sorbitol pathway and the relationship between glucose and psychiatric disorders,” recalls Regenold, adding that not many researchers are looking at the relationship between metabolism and psychiatric disorders. “Analyzing samples of patients’ spinal fluid taken here and at the National Institutes of Health, we found a modest but statistically significant elevation of sorbitol in patients with bipolar disorder and major depression. Interestingly, patients with bipolar disorder have a twofold increase in the risk of diabetes.”

ILLUSTRATION BY LISA ADAMS

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Regenold told Shapiro that he wanted to find out interested in learning how the ERK pathway is regulated whether increased brain sorbitol levels were related to the and how cell regulation by ERK affects cell proliferation. disease process underlying mood disorders in some patients. “ERK activity is important for regulating cell growth,” he As they hummed along the Light Rail, Regenold also told says. “If we can regulate ERK, we may be able to improve Shapiro of the beneficial role of sorbitol in some animals when it acts as an “antifreeze,” protecting mammals and insects from the stresses of the cold environment, keeping them alive during winter hibernation. The human body also manufactures small amounts of sorbitol, which plays a role in kidney function and is involved with the pathway used to nourish sperm. As they continued to talk and ride the rails, Shapiro bounced an idea off Regenold: Just as sorbitol protects hibernating animals, might it also help protect cancer cells in tumors from the stress of chemotherapy, a chemically induced stress meant to destroy cancer cells? If that protective role for sorbitol could be counteracted, reasoned Shapiro, cancer cells might be rendered more susceptible to chemotherapy. Then, perhaps less chemotherapy could be administered, making the chemotherapy regimen easier on patients. The result of their collaboration is a joint paper spelling out those possibilities. It will soon be published in the journal AntiCancer Drugs. In the paper, Shapiro and Regenold theorize that therapy with aldose reductase inhibitors, in concert with chemotherapy, may be effective because of an intracellular protein pathway called “the extracellular signal-related kinases” (ERKs), which regulate Sorbital, which can be found in white ash berries, may provide answers cell proliferation. to treating cancer. “Our research is focused on understanding the mechanisms by which cells respond to extra cellular signals and generate a biological response,” says chemotherapy’s effectiveness in killing cancer cells.” Shapiro, who started his career as a bacteriologist. “One way Shapiro’s work is funded by a $100,000 grant from the cells respond to signals is through the activation of protein Concern Foundation and a $50,000 grant from the U.S. kinase cascades, a chain of events that regulate protein Department of Defense. Shapiro is the principal investigaactivity such as we see with the ERKs.” tor for both grants. “These pathways have been implicated as regulators of Although Boussingault could not have anticipated normal cell growth and tumor cell growth,” points out that his discovery of sorbitol would have such farShapiro. reaching influence, he may well have understood how Shapiro’s lab, which will be moving to Health Sciences an unexpected collaboration can scientifically address Facility II when the building is completed this spring, is some of life’s mysteries.

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the Genetics of Longevity Scientists look to Old Order Amish for the secret to long life. BY SONIA ELABD “COUNT BACKWARD FROM 100 BY SEVENS,” THERESA ROOMET, A RESEARCH NURSE, SAYS TO 65-YEAR-OLD “MARK,” WHO IS SEATED NEXT TO HER AT A SMALL KITCHEN TABLE IN A FARMHOUSE IN LANCASTER COUNTY, PA. “THAT’S NOT EXACTLY EASY!” MARK REPLIES, GRINNING AT ROOMET. HIS GAZE DRIFTS TOWARD THE CEILING OF HIS

mother’s kitchen as he begins to count. “93 … 86 … 79 …” From across the table, Mark’s mother, “Laura,” 91, watches quietly, her hands resting in her lap on the folds of her black Amish apron. Roomet straightens her blue gingham dress, her Amish nurse uniform as she calls it, and writes the numbers on a sheet of paper. This exercise is the first of several to measure Mark’s ability to remember and concentrate. The week

before, Roomet asked Laura to do the same exercises. Laura has opened her home to Roomet through an Amish liaison as part of a study on the genetics of longevity. The five-year, $3,555,275 study is funded by the National Institute on Aging, National Institutes of Health, and the principal investigator is Alan R. Shuldiner, MD, a professor in the School of Medicine. He is working with Nir Barzilai, MD, director of the Institute for Aging at the

PHOTOGRAPH BY PICTUREQUEST

Albert Einstein College of Medicine in New York. Barzilai is studying longevity in Ashkenazi Jews, and Shuldiner is focused on the Old Order Amish. Shuldiner’s coinvestigators at the University of Maryland include Braxton D. Mitchell, PhD; John D. Sorkin, MD; Anne Cappola, MD; and Elizabeth Streeten, MD. “We’re not looking for the fountain of youth,” says Shuldiner. “Rather, we are looking for genes that prolong life and protect people from disease.” Old Order Amish and Ashkenazi Jews are ethnic groups that are particularly suited for longevity research because they have longer than average life spans. “Many Amish, even in the 1700s, were living into their 70s and 80s, while the rest of the population was dying, on average, in their 40s,” says Shuldiner. The two groups are ideal for genetics research for another reason: because they are founder populations—groups that descended from a relatively small number of individuals. Most of the about 20,000 Old Order Amish in Lancaster County descended from roughly 200 individuals. About 90 percent of the more than 6 million Jews in the United States are Ashkenazi—Jews who emigrated from eastern and northern Europe. Because relatively few individuals within these founder Alan Shuldiner populations have married outside their culture, these groups have remained genetically isolated. Also, within any founder population, such as the Amish, there is greater similarity of lifestyle, including diet and levels of physical activity. These similarities may further help researchers tease out the effects of genetics on longevity. By studying people who share genes, the hunt for a particular gene, among the multitude of twisting and turning strands of DNA unique to each person, is less daunting. For example, genetic similarities among the Ashkenazi population have helped scientists find genetic mutations linked to breast cancer. To find the longevity genes, Shuldiner, Barzilai, and their colleagues collect a variety of information from people over the age of 90 (referred to as probands); their children, who may have inherited some of the longevity genes; and their children’s spouses, who serve as the control group. The study compares the probands’ physical abilities and DNA with their children’s. Because the Amish keep extensive family records, Shuldiner also can see how long a proband’s parents and siblings lived. Shuldiner and Barzilai have based their study on two observations in people over age 95. First, most people who reach this age did nothing in particular to extend their lives, such as exercise or eat a healthy diet. Second, people who

live to be 95 years old usually have siblings and parents who also lived that long. For the average person, life span is determined mostly by environment. For people older than 95, genetics is a much stronger influence. Earlier research has found four possible genes that may influence longevity: a gene that helps regulate blood pressure, one that may provide better resistance to infections, one that regulates blood clotting, and another involved with lipid metabolism and possibly Alzheimer’s disease. “If we find a longevity gene that protects against a certain disease, such as cardiovascular disease,” says Shuldiner, “it could lead to the development of drugs that mimic that gene’s protective effect.” The unique genetics of the Old Order Amish make them ideal subjects for studies not only in longevity, but in specific disease areas as well. Shuldiner, whose primary area of research is diabetes, has been studying the Amish since 1993. So far, his studies have led to the identification of regions of chromosomes, called loci, that are likely to harbor genes for type 2 diabetes as well as hypertension. Shuldiner, who is the director of the Joslin

“We’re not looking for the

fountain of youth,” says Shuldiner.

Diabetes Center at the University of Maryland, and his colleagues, conduct studies on the genetics of autoimmune thyroid disease, cardiovascular disease, diabetes, hypertension, and osteoporosis in the Amish with hopes of finding the genes that relate to those conditions. Since the fall of 2001, Shuldiner and Barzilai have recruited about 250 families for the longevity study. Both researchers plan on recruiting many more participants and say they are making progress. But for now, the secret to long life remains tucked away in the corn fields of Pennsylvania, in the plain farmhouses of Lancaster County, encrypted on the twisted DNA strands of the Old Order Amish.

Searching for Effective Treatments in the

Obesity Epidemic The science of obesity offers hard truths for dieters and serious challenges for researchers.

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2003

UNIVERSITY

BY ELIZABETH MCKENNA

BARBARA C. HANSEN, PHD, WHO HAS STUDIED OBESITY FOR MORE THAN 20 YEARS, SAYS THAT MANY, EVEN MOST, AMERICANS WILL GAIN WEIGHT AS THEY GET OLDER—

even if they eat a relatively low-fat, high-fiber diet. The reasons people gain weight in middle age are both genetic and physiological. The environment plays a role, but is neither the cause, nor the route to a quick fix. Exercise and a little self-control—the media’s mantra for weight loss—are quite simply not powerful enough to help most overweight or obese people lose significant weight, she says. “Obesity is driven by our genetic makeup, coupled with an environment that sets no limits on the availability of food, and presents us with no predators. After all, fat animals would be killed very quickly in the wild,” says Hansen, a physiology professor in the School of Medicine. “What we are seeing today,” she says, “is the ‘modern world syndrome,’ the expression of our individual, underlying predisposition toward gaining weight and keeping it on.” In late 2001, U.S. Surgeon General David Satcher issued a Call to Action report that described the scope of the problem and strategies to reverse it. It cited statistics that an estimated 61 percent of adults, and 13 percent of children and adolescents, are overweight or obese. Maryland is no exception; obesity has nearly doubled, from 11.6 percent of the population in 1991 to 20.2 percent in 2000. With the increase come myriad adverse health effects: diabetes, stroke, hypertension, high cholesterol, and premature death. Although Hansen agrees with the nature and scope of the obesity epidemic, she differs on the best ways to treat it. She is not optimistic about the frequently recommended prevention strategies—obesity education, increased exercise, and sensible portions of low-calorie food. “I don’t think they’ll be sufficiently effective,” she says. “There’s minimal evidence that supports their usefulness in producing significant, sustained weight loss.” To find methods for weight reduction and new treatments for obesity and diabetes,

Hansen prefers to use lessons from her animal research. diabetes, and aging in the fourth year of a five-year, $3.7 Obesity is, in a small group of people, driven by the few million grant from the National Institute of Aging of the known genetic defects that induce increased body fat. But National Institutes of Health (NIH). “We’re looking for most obesity develops as people or animals move into biomarkers of aging, and examining the interactions of middle age, and the exact genetic and physiological aging and diseases, in association with mechanisms for this “garden variety” form of obesity calorie restriction,” she says. Hansen are unknown. This is the form of obesity that is linked hopes to compare physiological and with the onset of type 2 diabetes, a phenomenon with biochemical differences between dietwhich Hansen is familiar after years of working with restricted and unrestricted monkeys, monkeys, who, just like humans, frequently and withand to understand the natural procout apparent cause develop obesity and type 2 diabetes. esses of aging and diabetes. In her research, Hansen observes the natural onset “The key to preventing middleof obesity and diabetes from unknown genetic and aged obesity and diabetes onset is physiological causes in many of her middle-aged mongoing to be a combination of several Barbara Hansen keys, even though they are fed an American Heart factors,” says Hansen. “Primarily, it Association-recommended diet—one low in fat and will be calorie restriction combined high in fiber. Hansen says that the onset of obesity is highly with pharmacological interventions, with a limited contribuassociated with the onset of many physiological and biotion from supreme motivation—using the brain to overchemical changes associated with aging and diabetes. She come physiology.” has defined nine stages in the natural history of diabetes, Hansen’s views seem well supported by human study hallmarked by decreasing insulin sensitivity and the data, too—evidence she examined during a comprehensive dysfunction of insulin-secreting pancreatic cells. The full review of clinical trial studies undertaken while on a expression of diabetes can result in neurological, kidney, eye, committee to formulate obesity guidelines for the National vascular, blood pressure, blood lipid, and other pathologies. Heart, Lung, and Blood Institute of the NIH. “Our findIn an ongoing study that spans 20 years, Hansen is ings did not support a significant role for exercise in weight examining the effects of calorie restriction on obesity and loss,” says Hansen. “Losses were well within the weight diabetes in aging monkeys. One group of monkeys has fluctuations people routinely experience. Although exercise unlimited access to healthy food. The other group is mainplays a role in general fitness, it is not a magic bullet for tained at their youthful weight (equivalent to the weight a weight loss. human might be at age 20) by eating the same heart-healthy “The reality,” she says, “is we just don’t have effective food, but only enough to maintain a stable, healthy weight treatments for obesity,” and its underlying causes are and prevent weight gain. unknown. “Obesity is actually a complex regulatory probThe results are striking. The unrestricted monkeys lem,” Hansen states, “with a powerfully controlled ‘set frequently develop obesity, just as in humans, and a specpoint’—one that’s specifically designed to maintain our trum of ill effects. The calorie-restricted monkeys, on the weight at its current level,” and disallow weight loss, a other hand, show greater average longevity, no obesity, no potential survival threat. For some obese and overweight stages of diabetes, less cardiovascular disease, fewer strokes, people, she believes pharmaceuticals will be their only means lower blood sugar, and lower blood pressure. In fact, the of losing weight and keeping it off. restricted monkeys show nearly the same degree of health as Her additional research focuses on discovering pharmathey showed when they were young, and most have already cological interventions—ones that induce an artificial calorie outlived the average laboratory life span of primates, which restriction by enhancing insulin sensitivity, among other is 23 years. All are in their late 20s or older. (Monkeys can approaches. In 2002 alone, she received more than a million live as long as 40 years—comparable to 120 human years.) dollars from pharmaceutical companies to support this Could caloric restriction be the fountain of youth? important research; past grantors include Lilly, Hansen thinks not, but “it’s likely to substantially increase GlaxoSmithKline, Merck, and Sankyo Pharma. the average life expectancy.” Although, in mice, calorie Hansen attributes her unflagging interest in obesity and restriction can double the length of life, helping people to diabetes to there always being something new to be live to be 240 years old is not a likely outcome of restricting discovered and learned. “I wanted to be in a field with a calories in humans. Nevertheless, her studies show that with direct connection to a behavior controlled by the brain moderate restriction, sufficient to prevent excess body fat, (eating) and a physiological response (developing obesity/ life will be healthier and longer. diabetes),” she says, “a field where the answers wouldn’t all Hansen is also studying the connections between obesity, be provided within my lifetime.”

Internet2 Increases Opportunities for Collaboration BY ERIC BROSCH

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IN THE FALL OF 1998, WHEN THE UNIVERSITY OF OKLAHOMA LOST A FACULTY MEMBER AT THE BEGINNING OF THE SEMESTER, GARY HOLLENBECK, PHD, ASSOCIATE

dean of academic affairs in the University of Maryland School of Pharmacy, stepped in to help teach a drug delivery class over the Internet. Although the students in Oklahoma were easy to work with, says Hollenbeck, the technology was not. “The audio would be garbled, the video would hang up, and some slides would take a long time to show up at the remote site,” he says. “It was all a function of bandwidth and traffic.” The next time Hollenbeck teaches a course via videoconferencing, bandwidth and traffic won’t be issues, because last summer the University became a member of Internet2. Internet2 is a consortium of about 200 universities in partnership with industry and government. Sometimes called “tomorrow’s Internet,” Internet2, which is available only to U.S. colleges and universities, is linking the nation’s research community in ways that the publicly accessible “commercial Internet” cannot. For example, file transfers via Internet2 are exponentially faster. In one test, researchers measured the time it takes to download a feature-length movie in DVD format. Using a 56k dial-up modem, it took 171 hours to download “The Matrix.” With the type of connection the University uses to

tions. “The only way they can share the development and analysis of their research, with large data sets or images like X-rays, is through a very high-speed network,” says Murray. “Otherwise they have to discuss information over the phone, send it through the mail, or travel to meet each other.” One faculty member investigating Internet2 is Colin F. Mackenzie, MD, in the School of Medicine. He is evaluating the use of Internet2 and related technologies to better care for patients being transported to the University of Maryland Medical Center. Using wireless telecommunications equipment in ambulances and Internet2 in the emergency room, paramedics and doctors can transmit video and data to speed up the diagnosis and treatment of patients. “If we suspect the patient has had a stroke, we can do a complete neurological exam while the patient is on the way to the hospital,” says Mackenzie. Instead of going to the ER, stroke patients go directly to CT scan, where doctors can determine if the stroke is hemorrhagic or ischemic, that is, caused by bleeding or a clot. Patients with ischemic stroke can be given a clotbusting drug, tPA, which can restore blood flow to parts of the brain impaired by the stroke. However, tPA is effective only within three hours of the stroke onset. By combining Internet2 and wireless technology, Mackenzie’s teams can shave 30 minutes off the time it takes to make a diagnosis, allowing 15 percent more patients to be candidates for the clot-busting drug. Mackenzie, who is the director of the School of Medicine’s Charles McC. Mathias Jr., National Study Center for Trauma and Emergency Medical Systems, says he prefers working with Internet2 because of its broader bandwidth and the reliability of the connection. “We can do tremendous things with technology,” he says.

Using a 56k dial-up modem, it took 171 hours to download “The Matrix.” access the commercial Internet, it took 6.4 hours. With Internet2, it took 30 seconds. Access to technology this powerful will lead to more research funding opportunities for the University, says Peter J. Murray, PhD, vice president for information technology and chief information officer. He says that the National Institutes of Health is tailoring many grants for collaborative efforts among co-principal investigators at different institu-

With Internet2, it took 30 seconds. “But the systems have to be reliable for people to want to use them.” Internet2 opens up limitless possibilities for delivering University expertise throughout the country, says Murray. “Access to this technology gives the faculty an edge when competing for top grants and the best students.”

HSF II to Increase Research Space

THIS SPRING, THE UNIVERSITY OF MARYLAND WILL MARK THE OPENING OF HEALTH SCIENCES FACILITY II (HSF II), A $67 MILLION, 101,000-SQUARE-FOOT BIOMEDICAL research facility shared by the schools of medicine and pharmacy. The individual and combined research efforts of the two schools may lead to important discoveries in basic science, disease prevention, and treatment. Five labs will be housed in HSF II:

School of Medicine Nuclear Magnetic Resonance Facility: The basement of HSF II will house a new $2.5 million nuclear magnetic resonance (NMR) system, the most advanced system of its kind in the world. The 800-MHz NMR spectrometer will be used to analyze the structure of many proteins, including those found in cancer cells. NMR data can then be applied to drug design. Superconducting currents produce the magnetic field, so the temperature inside the magnet must be kept at -271 degrees C. The room housing the magnet is specially designed in terms of space, temperature, and humidity control. BSL 3: The new Biosafety Level Three (BSL 3) will be a containment laboratory for research involving emerging pathogens, such as the West Nile virus and agents of bioterrorism. The BSL 3 will allow research to be conducted in a safe environment for both the researchers and those in the vicinity of the research. Construction of the $4.5 million lab was supported by a $2 million matching grant from the National Institutes of Health National Center for Research Resources.

School of Pharmacy PBL: The Pharmacokinetics/Biopharmaceutics Laboratory (PBL) is a multidisciplinary unit within the departments of pharmaceutical sciences (PSC) and pharmacy practice and science (PPS). The mission of the laboratory is to better understand how drugs are absorbed, distributed, and eliminated in the body and how these attributes relate to both effect and toxicities. Researchers in the PBL will solve problems observed in the clinic using experiments performed in the laboratory. Areas of research include drug delivery, kidney disease, cancer, and infectious diseases. NMR and X-ray Crystallography Labs: A common objective of these projects is to develop novel therapeutic agents to treat human disorders. Three primary areas of research in the labs will include: 1. Heme protein structure and electroreactivity directed at developing agents to treat anemias, such as methemoglobinemia. 2. Structure and interactions of Human Interleukin-5 aimed at creating novel therapeutic agents to treat asthma. 3. Opioid peptide structure and receptor subtype specificity directed at developing novel agents to treat opiate addiction. Molecular Modeling Lab: The lab will use mathematical models to understand the relationship of the structure of biological and drug molecules to their functions. These models, in combination with computers, are referred to as molecular modeling and create an atomic picture of molecules. Molecular modeling for drug design projects decreases the time and money required for developing new therapeutic agents for human disease. Current studies in the molecular modeling lab include drug design efforts targeting cancer and AIDS and studies related to the atomic structures of proteins, DNA, and RNA to their biological functions.

The Promise of Pharmacogenomics BY RANDOLPH FILLMORE IN THE BRAVE NEW WORLD CREATED BY THE HUMAN GENOME PROJECT—THE AMBITIOUS AND SUCCESSFUL ENDEAVOR TO MAP ALL THE GENES IN THE HUMAN BODY—WHAT SPINOFF HOLDS THE MOST HOPE OF IMPROVING HEALTH CARE IN THE 21ST CENTURY? IT’S THE RISE OF

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pharmacogenomics, the science of custom-fitting drug treatment to an individual’s genetic makeup. Pharmacogenomics, which promises to optimize drug discovery, development, and patient treatment, could be a giant leap from “one size fits all” therapy to a this-drug-is-for-you future. However, that future is fraught with questions—scientific, economic, legal, and ethical. Here, some of those questions are posed to a panel of experts: Russell J. DiGate, PhD, professor and associate dean for research and graduate education, School of Pharmacy; Paul S. Shapiro, PhD, assistant professor, School of Pharmacy; C. Daniel Mullins, PhD, associate professor, School of Pharmacy; and Karen H. Rothenberg, JD, MPA, dean, School of Law. What was learned from the Human Genome Project? Russell DiGate: One result of the project was the improvement of genetic mapping, which helps make the hunt for specific disease genes faster, cheaper, and more practical. Genetic mapping is a process used in the discovery of DNA markers. DNA markers can tell researchers, roughly, where a gene exists on a given chromosome. The more DNA markers there are on a genetic map, the more likely it is that one will be closely linked to a disease gene and made easier to target. Mapping has already been used successfully to find the single genes for several diseases, such as cystic fibrosis and muscular dystrophy.

What is pharmacogenomics? Russell DiGate

Paul Shapiro

RD: Pharmacogenomics is the science of applying genetic infor-

mation to drug design, development, and delivery using our new understanding of how genes respond to stimuli. In the broadest sense, pharmacogenomics applies not only to traditional drugs, but to bioengineered proteins and gene therapy as well. Pharmacogenomics is not new. It’s an extension of work we have been doing for some time, but augmented by knowledge gleaned from mapping the human genome. What does pharmacogenomics offer in terms of therapy? Daniel Mullins

Karen Rothenberg

genes can provide better, and perhaps safer, therapy. In designing targeted drugs to treat cancer, for example, we will likely find a series of genes or receptors—not just one—involved in what we call the oncogenic pathway, the cascade of events that leads to disease. The difficulty will be in determining which genes, or receptors, to target. We may not have the resources to target all of them during research and development. However, by virtue of our knowledge about the pathways, researchers will design systems, or use animal systems, to look at the responses and predict side effects before they happen. How will drugs be designed to target specific genes, diseases, or receptors?

What ethical and legal questions will arise when screening for disease using an individual’s genetic makeup?

Paul Shapiro: Identifying the genes that are involved in a

Karen Rothenberg: One of the promises of the Human

particular disease is the easy part. Understanding the function of the proteins that these genes encode is more difficult. Proteins contain many structural motifs and undergo a variety of post-translational modifications that regulate the proteins’ structure and function. Identifying the structure, modifications, and specific function of proteins is non-trivial and is compounded by the fact that many proteins function only through interactions with other proteins in multiprotein complexes. Yet, drug and biotech companies, and academic researchers as well, are spending a lot of resources developing drugs that specifically inhibit proteins involved in human diseases, such as the development of specific inhibitors of growth factors and their receptors for preventing cancer cell proliferation. So, the real importance in the work arising from pharmacogenomics will be in proteomics— the characterization of proteins.

Genome Project is that our genetic susceptibility to common disorders can be better understood, allowing for individualized, preventive, and therapeutic medicine through drugs designed for specific genetic targets. Our enthusiasm for the data coming out of the Human Genome Project has, however, been chilled by the fear that genetic information will make us vulnerable to discrimination. This discrimination could come at the hands of employers or insurance companies, as it is reasonable to assume that health insurers and employees may not fully understand the implications and limitations of genetic test results. Just as with other new technologies, negative consequences can be anticipated. To date, there is no comprehensive federal legislation that addresses genetic discrimination and privacy in insurance or employment contexts. The sooner we act to protect genetic information and prevent genetic discrimination the better.

Will pharmacogenomics make drug development and testing more efficient? Daniel Mullins: Given that 80 percent of compounds fail in clinical trials and the industry spends $500 million to $700 million for each new drug approval, the benefits of applying pharmacogenomics to drug development may be substantial. Pharmacogenomics could also be used to determine exclusion criteria for participants in clinical trials, thereby saving time and money.

RD: Nearly all diseases have a genetic component. And, we know

that drugs are metabolized by enzymes, which are themselves genetic products, distinct in genetic groups as well as in individuals. Some drugs are effective for some people and not for others because of genetic differences among individuals. Once those genetic differences are known, drugs can be matched to the variations. An ability to identify and target specific proteins and

costs of these tests may be offset by the savings realized when ineffective treatments are avoided. Up to $80 billion is spent every year in the United States for treatment associated with drug-related adverse events in hospitalized and ambulatory patients. Pretesting patients to determine those who will not respond to a therapy, or those who may have an adverse effect, could present a significant savings in terms of health care costs. Pharmacogenomics will be cost-effective if increased costs associated with genetic testing are less than the value of improved health outcomes.

Is pharmacogenomics likely to increase or decrease the cost of health care? DM: Pharmacogenomics testing could increase the average

cost of treatment. The issue is that clinical trials could become more costly because pretesting will be required to determine which patients should participate. However, the

How will pharmacogenomics change the education of pharmacists and their practice? RD: Pharmacy education will become more molecular.

Because drugs are the niche of pharmacy, pharmacy needs to keep up with innovations in drug design, development, and delivery. Our department focuses on those three Ds. There will be new technology installed in Health Sciences Facility II to address the three Ds related to the investigation of the structure of genes and proteins involved in disease states and the subsequent development of compounds that will interact with them. The role pharmacists play will be determined, in part, by the degree to which other health care professionals shape it, what responsibilities pharmacists want to take, and how they embrace the future.

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UNIVERSITY

BY JIM DUFFY WHEN MICHAEL GREENBERGER, JD, LOOKED UP FROM HIS DESK AT THE U.S. DEPARTMENT OF JUSTICE ONE DAY IN FEBRUARY OF 2000, HE HAD NO INKLING THAT HIS PROFES-

sional life was on the verge of a transformation. There stood his boss, Janet Reno, the nation’s attorney general. Greenberger’s best memory is that she said something like: “Michael, I’m going to make you a counterterrorism star!” She asked Greenberger to assume a major role in planning the nation’s biggest-ever mock terrorism drill. Greenberger had no experience in the counterterrorism field. He’d spent 24 years handling trial and appellate litigation at the Washington, D.C., law firm of Shea & Gardner. He’d spent two years directing the Commodity Futures Trading Commission’s Division of Trading & Markets, which oversees the complex world of exchange-traded futures and derivatives.

But Greenberger had always prided himself on being a quick study with new challenges. And his management background gave him confidence in his ability to pull off big projects that depend on sustained teamwork. He had two months to assemble the exercise, which would come to be known as TOPOFF, an abbreviation for the “top officials” whose responses were being tested. “That threw me right into the middle of it,” Greenberger recalls. “All of a sudden, I was down there every day with the FBI, the CIA, the National Security Council, the CDC, and the Department of Defense. It was very, very intense.” The TOPOFF drill Greenberger orchestrated that spring unfolded simultaneously in two cities and involved many members of then-President Clinton’s Cabinet. A dozen Black Hawk helicopters descended on Portsmouth, N.H., in response to a chemical explosion. A bioterror attack in

PHOTOGRAPH BY ANN GRILLO

Michael Greenberger Leads Center for Health and Homeland Security

Denver left 600 actors feigning symptoms of the plague. A separate but related exercise planned by Greenberger simulated an attack on the suburbs of Washington, D.C. Lessons learned during TOPOFF helped medical, political, and military leaders improve plans for responding to terrorist attacks that inflict mass casualties and illnesses in numbers capable of overwhelming the public health system. The exercise was such a success that Greenberger became a fixture on the Justice Department counterterrorism team. Greenberger stayed at the Justice Department until the Bush Administration took over. After signing on as a visiting professor at the University of Maryland School of Law in 2001, he assumed his days in counterterrorism were behind him. Then came September 11, 2001.

University of Maryland President David J. Ramsay, DM, DPhil, was in London when hijacked airplanes crashed into the World Trade Center, the Pentagon, and a field in rural Pennsylvania. While stranded overseas for most of a week, Ramsay e-mailed the deans of the schools of dentistry, law, medicine, nursing, pharmacy, and social work, asking each for summaries of terrorism-related work their faculty had under way. As responses rolled in, Ramsay began to see just how well his university was positioned to help boost the safety of the American public in the coming fight against terrorism. Long before that Sept.11, every UMB school had terrorism-related projects in the works. Some of the undertakings are well known. The Center for Vaccine Development (CVD), which operates in the School of Medicine, is the only university center in the world engaged in a full range of

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These programs represent only a sample of dozens of studies, centers, projects, and individuals detailed in the deans’ replies to Ramsay’s Sept. 11 e-mail query. By the time the president got a flight back to Baltimore, he had already decided that “what we needed to do now was to pull all these things together.” Eight days after the attacks, Ramsay appeared at a terrorism teach-in that was arranged by the School of Law for concerned students and faculty. “The auditorium was packed,” Greenberger recalls. “That’s where I first heard President Ramsay talk about the need for a powerful new center to help coordinate all the work that was going on across this campus.” Last spring Ramsay tapped Greenberger to head the new Center for Health and Homeland Security (CHHS). Formally established in May, the center operates under the guidance of a board of directors consisting of Ramsay and the deans of six UMB schools. No other center in the University has that level of high-powered leadership.

“Some people might think we’re biting off more than we can chew, but I think the

University is well-positioned here.” Michael Greenberger with former boss Attorney General Janet Reno.

Smallpox Virus, Poxvirus Variola, under the electron microscope

“Normally, responsibility for program administration should be as close to the academic units as possible,” Ramsay says. “But we thought this center was so important that I would oversee it with the deans for the first year or two, just to highlight the importance of this initiative.” Greenberger spent the summer months laying the groundwork for the CHHS. That meant tending to innumerable start-up details, such as launching a Web site, publishing a brochure, planning a fellowship program, and creating a lengthy survey of the campus’s counterterrorism capabilities. It also meant meeting with faculty and administrators across campus to envision the limitless possibilities ahead. “There are no models for this center,” Greenberger says. “There is the Center for Civilian Biodefense Strategies at Johns Hopkins, but that focuses only on the public-health aspects of terrorism. We want the CHHS to provide leadership in crisis management and intelligence issues, and

SMALLPOX: COURTESY OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION; GREENBERGER AND RENO: COURTESY OF THE DEPARTMENT OF JUSTICE

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vaccinology, from basic science through vaccine development, clinical evaluation, and field studies. The School of Nursing has for years been training U.S. military and embassy personnel to deal with crises involving heavy casualties. Other initiatives operate with a lower profile. Dental School Professor Louis DePaola, DDS, investigates how to identify bioterror agents during oral exams. Other Dental School professors are experts in forensic identification—two were called to the Pennsylvania crash site to identify victims. The counseling expertise available at the School of Social Work can be employed to help victims and families maintain their emotional equilibrium in the face of tragedies. Faculty involved with the School of Law’s Law & Health Care Program can help examine public health strategies— mandatory quarantines in the wake of a bioterror attack, for example—as they touch on thorny questions of civil liberties and privacy.

expertise in prevention, public health, and consequence management. Some people might think we’re biting off more than we can chew, but I think the University is wellpositioned here.” School of Medicine Vice Dean Frank Calia, MD, MACP, agrees. “We have on this campus one of the largest groups of scientists and clinicians in the country whose main interests are infectious diseases,” he says. “We’re working on emerging pathogens, transmission and epidemiology, vaccine and new drug development—it just goes on and on.” Calia believes that a center like the CHHS can help push this work to new levels by boosting collaboration between disparate departments and schools. “This university has a mind-boggling amount of talent at its disposal,” he says. “One problem in a big place like this is that we may not be aware of people in other buildings who know how to deal with problems we’re facing.” As founder and director of the Center for Vaccine Development (CVD), Myron Levine, MD, DTPH, has spent his career seeking innovative ways to combat infectious diseases. Many of the techniques and strategies for creating vaccines developed at the CVD hold great promise for future work on potential bioterror agents. “This new center has a vitally important job to do in bringing people together through one organization and creating new lines of communication between the schools,” Levine says. “It can also act as a starting place for potential funders and foundations.” By summer’s end, the CHHS was already at work on

another aspect of its mission—direct educational service to the public. In September, the center hosted a session evaluating public-policy issues in the first year after the terrorist attacks. In November, it led the annual Community Issues Forum on campus. Down the road, Greenberger, who has already established a course in homeland security and the law of counterterrorism for the School of Law, hopes to establish an interdisciplinary counterterrorism curriculum open to all UMB students. The center’s other major undertaking is helping to shape a proposed Center of Excellence for Bioterrorism and Emerging Infections for the mid-Atlantic region. The National Institutes of Health plans to set up as many as eight such centers, each of which will be based in multiple institutions. Preliminary discussions on how to structure an application for the proposed mid-Atlantic center involve not just the University of Maryland, but Johns Hopkins University and other Maryland institutions, along with academic medical centers in Washington, D.C., Virginia, and Pennsylvania. “It seems clear that most of the increase in the NIH budget this year will be linked to homeland security,” Ramsay says. “This NIH increase gives the CHHS the opportunity to help establish a network that is rich in both depth and breadth.” Says Greenberg: “With the outstanding leadership, research, scholarship, and policy development occurring within the University’s six professional schools, CHHS is well-positioned to play a vital role in the most critical national security and public health issue facing the nation.”

ADDRESSING TERRORISM t was the breadth of clinical, research, and educational expertise on the University of Maryland’s campus that led President David J. Ramsay to establish the CHHS. Below is a sampling of terrorism-related projects under way at the University’s six schools.

DENTAL SCHOOL • The School has prepared a professional development course for Maryland dentists called “Bioterrorism: Dentistry’s Role in Recognizing and Responding to the Threat.” SCHOOL OF LAW • Faculty members specialize in privacy and civil liberties issues related to the detention of terrorism suspects and the exercise of special emergency powers by the government.

SCHOOL OF MEDICINE • After the Sept. 11 attacks, the National Institutes of Health called on the Center for Vaccine Development to test the effectiveness of a diluted smallpox vaccine. • The School is in the midst of a three-year program to train up to 300 U.S. Air Force medical personnel in trauma care. • Neurobiologists in the Program in Neuroscience are investigating the basic workings of biological weapons that target brain functioning, such as the nerve agent sarin and the neurotoxin botulinim. SCHOOL OF NURSING • The School has a special training program on handling mass casualty situations. • Two county health departments turned to the School of Nursing for

training on how to respond to a bioterrorism event. SCHOOL OF PHARMACY • The Maryland Poison Center is developing procedures and protocols for distributing medications in response to bioterrorism attacks. • A new course at the School focuses on chemical and biological agents most likely to be used in a terrorist attack. SCHOOL OF SOCIAL WORK • Faculty members are studying ways that employee assistance programs can be adapted to provide counseling in the event of bioterrorism incidents. • As the former top social worker with the U.S. Army, Dean Jesse J. Harris, PhD, offers expertise in counseling soldiers and their families.

Studying

Schizophrenia The Maryland Psychiatric Research Center is a leader in the study of schizophrenia and the treatment of people with this devastating disease. BY NANCY GRUND Illustrations of dopamine D-4 receptors in human (post-mortem) brain tissue. The figure on the left shows a normal brain region; the image on the right shows a schizophrenic brain region.

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WHEN WILLIAM T. CARPENTER JR., MD, JOINED THE MARYLAND PSYCHIATRIC RESEARCH CENTER (MPRC) AS ITS DIRECTOR IN 1977, THERE WERE NO BEDS, NO

clinics, no computers, and no competitively funded research scientists. In fact, the joint venture of the School of Medicine and the Maryland Department of Health and Mental Hygiene was close to losing its state funding. In September 2002, the MPRC celebrated its 25th anniversary as one of the premier research centers in the world for the study of schizophrenia. In 2001, the center garnered almost $14.5 million in competitive research funding. It has been a host institution to a federally funded Schizophrenia Intervention Research Center, a Clinical Research Center, and a Center for Neuroscience and Schizophrenia. In addition, two of the first five merit awards for schizophrenia research from the National Institute of Mental Health were granted to MPRC scientists. The mission of the MPRC is to study the causes and symptoms of schizophrenia, improve diagnostic capabilities, and offer innovative treatments for the disease. A chronic, severe brain disorder that William T. Carpenter affects more than 2 million Americans, or about 1 percent of the population, schizophrenia affects an individual’s ability to think, feel, work, maintain personal relationships, and distinguish between reality and the imaginary. One of the most significant factors in the center’s continued success in the study of schizophrenia is its union of basic brain research and clinical investigations. “We have basic neuroscience and clinical applications all in one setting. There is a great deal of interaction among clinicians and scientists at all levels,” says Carpenter, adding

that at the MPRC, thousands of Marylanders have gained access to methods of diagnosis and treatment that are not otherwise available. From 1952 to 1990, most patients with schizophrenia were treated with the first generation of antipsychotic drugs, which allowed them to live at state hospitals or return to their communities, but with many side effects. The second generation of antipsychotic drugs, introduced in the 1990s, were equally efficient but less likely to cause motor and cognitive side effects. At times, they were even more effective in treating delusions, hallucinations, and disorganized thinking. With the MPRC at the lead, Maryland became one of the first states to begin broad use of these second-generation drugs. Now, the MPRC has shifted its focus from the refinement of antipsychotic drugs to the exploration of novel mechanisms of drug action. It is part of an effort to introduce treatment for the negative symptoms of schizophrenia, such as low drive and restricted emotions, and cognitive impairments that limit a schizophrenic’s ability to function in daily life. The results may help even more people with schizophrenia keep jobs and participate in normal social networks. One of the most important discoveries at the MPRC was that schizophrenia classification contained several separate diseases, each with its own set of symptoms, signs, brain anatomy, pathophysiology, and related risk factors. MPRC scientists have also been leaders in connecting distinctive neuroanatomic activity to specific sets of symptoms and creating images of the effects of drug treatment in these select brain areas. Much of the MPRC’s work takes advantage of a unique resource at the center, the Maryland Brain Collection, a collaboration with the Maryland Office of the Chief Medical Examiner, that allows researchers to study human brains, post-mortem, with extensive clinical information

available on each specimen. The collection provides opportunities for unique analyses of the organization and structure of normal and schizophrenic brains. It also allows researchers to compare brains from disease subtypes. Through the MPRC’s Neuroscience Program, led by Robert Schwarcz, PhD, independent scientists head six laboratories focused on studying the causes and pathogenic mechanisms of schizophrenia. For example, Schwarcz’ own work on animal models has recently provided evidence that enhanced levels of kynurenic acid (KYNA), a neuroactive brain metabolite, might be critically involved in the cognitive deficits seen in many schizophrenic patients. “Twenty-five years ago, the field of schizophrenia neuroscience was in its infancy,” says Carol A. Tamminga, MD, head of the MPRC’s Inpatient Research Program. “Then, scientists used crude methods and had a distant understanding of brain function. Today, we have sophisticated methodologies to analyze brain function and an increased understanding of its mechanisms.” Recently, Tamminga and her colleagues have studied the effects of a new class of drug, partial dopamine agonists, or “stabilizers,” that more successfully and more gently modulate the dopamine system. Early clinical trials have shown that these drugs cause fewer or no cognitive side effects. In fact, scientists who work with inpatients have observed that the drugs are particularly effective in reducing symptoms in more than 50 percent of the most severely ill, persistently psychotic patients. Throughout the last two decades, thousands of patients have participated in clinical studies in the MPRC’s Outpatient Research Program. Led by Robert W. Buchanan, MD, the outpatient program currently sees about 100 patients. The program has played a major role in dosereduction studies, supporting the hypothesis that schizophrenic patients respond well to lower and safer doses of medication. The program continues to develop approaches

for treating severe episodes. It also develops innovative longterm treatments for schizophrenia, including targeting therapies for specific aspects of the disease. “Our goal, through research and clinical care,” says Buchanan, “is to optimize the level of functioning for these patients and enhance their ability to work and demonstrate social skills.” The Schizophrenia Related Disorders Program, led by Gunvant Thaker, MD, has conducted family studies of patients with schizophrenia over a 10-year period to identify and refine genetic markers for those at greatest risk for the disease. These studies show that subtle abnormalities in eye movements, attention, memory, and other cognitive functions may be inherited traits in families of schizophrenic patients. Different abnormalities are clustered in different families, supporting the concept of several diseases within the schizophrenia classification. Of all the recent initiatives of the MPRC, Carpenter is particularly proud of its six-year collaboration with the Swiss pharmaceutical company Novartis Pharma AG, a model academic/industry collaboration for public science. Their $24 million grant to the MPRC, the largest in the medical school’s history, is helping scientists gain a better understanding of schizophrenia at the molecular level and discover new drugs to treat the disease. After 25 years of research and treatment innovations, MPRC scientists are looking forward to the next frontiers of scientific discovery. With a laboratory facility under construction adjacent to its main building at the Spring Grove Hospital Center in Catonsville, Md., the MPRC is eagerly approaching a new era of molecular genetics and biomedical engineering. With the help of these advanced technological tools, MPRC scientists are confident that they can discover the causes of schizophrenia and continue improving the lives of individuals struggling to cope with this devastating disease.

Women’s Health A Little Funding Goes a Long Way BY DANIELLE SWEENEY

P H OTO G R A P H S B Y ST E V E N B I V E R

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FOR 10 YEARS,

the Women’s Health Research Group (WHRG) has promoted women’s health research among campus faculty and students by providing a forum for investigators to present information and identify opportunities for collaboration. The WHRG was created as an all-campus organization by faculty members from the School of Medicine’s Department of Epidemiology and Preventive Medicine, where it is based. In 1997, the WHRG was awarded a five-year educational grant from Parke-Davis (now Pfizer) that provided up to $50,000 a year for intramural grants in women’s health research. Since its inception, the WHRG has funded 45 projects in the schools of medicine, nursing, pharmacy, and dentistry in areas such as aging, drug metabolism, depression, and cancer. These one-year grants, which range between $5,000 and $10,000, fund pilot projects that can be used to compete for full extramural funding. Although the grants are small, the impact they may one day have on women’s health is significant. Already, the projects funded during the first four years of the program have resulted in 19 publications, 25 published abstracts, and the external funding of 11 related grants. Last fall, the WHRG received a five-year, $2,235,000 training grant from the National Institutes of Health to foster interdisciplinary research in women’s health among junior faculty scholars. The grant will support eight scholars as they work with senior faculty mentors and develop research careers. The projects of the four researchers profiled here are just a few examples of the innovative ideas being explored in women’s health at the University of Maryland.

Measuring Modesty and Its Effects on Women’s Health

Caryn Andrews The influence of religion on health care has been the focus of numerous studies, but one aspect of religious identity—modesty—and how it affects the way people access health care has not been examined closely. Caryn Andrews, CRNP, MSN, a nurse practitioner and doctoral candidate in the School of Nursing, is particularly interested in how modesty and religiosity among Jewish women might affect their use of mammography. “In Israel, only about 30 percent of women follow U.S. recommendations to get regular mammograms,” says Andrews. “And I believe women’s modesty and religiosity might be one of the reasons why. “The Jewish laws regarding modesty, called ‘tzniut,’ are explicit regulations of dress, behavior, and interaction with others, including health care providers. These laws are adhered to strictly by the most observant Jewish men and

women, and include covering one’s body from their clavicle to below their knees, wearing sleeves to their elbows, and covering one’s hair if married,” says Andrews. “Most Jewish people are aware of these regulations regardless of whether or not they adhere to them.” Andrews theorized that Jewish women’s modesty could make them less likely to get a mammogram—a breast cancer detection test. The procedure requires disrobing and a technician placing a woman’s breasts into the mammography machine, which compresses and flattens the breast. “Mammography, though vital, is an intimate and sometimes uncomfortable procedure for women, no matter what their level of modesty,” says Andrews. “It is easy to see how an especially modest woman might want to avoid the exam.” Because there is little research quantifying modesty, Andrews’ first task was to define it. “Modesty is something that many women talk about, but nobody really tells you what it is,” says Andrews. To develop a working definition of modesty, Andrews interviewed 12 Jewish women who represented the spectrum of religious observance. “Modesty means different things to different people,” she explains. “It’s not just about dress. It’s behavior. It’s interaction with other people. It’s the image they project.” Once Andrews considered the different definitions of modesty, she began developing a 30-point questionnaire to measure it. The WHRG funded her efforts. In the fall of 2001, she was awarded a $2,000 research grant. The grant support was important in non-monetary ways, Andrews says. “It validated my ideas and gave me confidence. My questionnaire is a unique tool, and other researchers are waiting for me to complete it. They want to use it in their own projects.” Andrews administered her questionnaire to 50 women in late 2002. With her results, she intends to seek funding from the National Institutes of Health and the Susan G. Komen Breast Cancer Foundation. “I want to conduct additional research in this area, exploring other cultures and the role of modesty in health care,” Andrews says. “As a practitioner, I hope to develop interventions to help modest women feel more comfortable about mammography.”

Hormones and Knees

Bill Romani Anterior cruciate ligament (ACL) injuries are one of the most common sports injuries, affecting an estimated 95,000 people a year in sports such as football, basketball, and soccer. Most ACL tears occur without contact, when the foot is fixed and the knee twists, stretching the ligament to the point of tearing. Treatment often requires surgery or physical therapy, and can prevent people from returning to sports for up to a year. Researchers aren’t sure why, but more women than men injure their ACLs. One theory suggests that hormonal

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fluctuations during the phases of the menstrual cycle make women’s ligaments more elastic and therefore more vulnerable to injury. In 2001, William Romani, PhD, PT, ATC, assistant professor in the Department of Physical Therapy in the School of Medicine, was awarded a $2,700 grant from the WHRG to help support his work exploring the possible connection between estrogen levels at ovulation and ACL stiffness. “We know that estrogen affects cancerous and reproductive tissues, but not a lot of research has been done on the effects of estrogen on ligamentous tissue,” Romani says. Previous studies of women with ACL injuries used female subjects between the ages of 18 and 40, adult, but premenopausal. Romani recruited 32 such volunteers, but ultimately only 20 of the subjects met his criteria. “They couldn’t be elite athletes, but they had to be active. They couldn’t be using oral contraceptives, but they had to have regular menstrual cycles for the past six months. If you think about it, these are tough criteria to fill. It took us two years to find these subjects.” Romani and his team took blood samples from the subjects and, with a knee arthrometer, measured the stiffness of their ACLs during the three phases of their monthly cycle—near ovulation, menstruation, and luteal. He found that increases in estrogen levels during the ovulation phase are negatively correlated with ligament stiffness: As estrogen levels rose, ACL stiffness, and the ability of the ACL to withstand force, declined. The bulk ($16,800) of Romani’s research was funded by the National Athletic Trainers’ Association. “The WHRG grant paid for additional analysis of our initial data,” he says. Romani’s next step is applying for a grant from the National Institute of Arthritis and Muskuloskeletal and Skin Diseases, National Institutes of Health, to investigate how estrogen and progesterone affect the ACL’s normal remodeling—the way the ACL tissue breaks down and rebuilds itself.

Estrogen and Thyrotropin Releasing Hormone Gene

Effects of Renal Disease on Liver Enzyme Activity in Women

Tom Dowling Thomas C. Dowling, PharmD, PhD, has been interested in kidney function since 1992, his last year of pharmacy school. “The kidney is a fascinating organ,” says Dowling. “It controls our body in many ways. It regulates our calcium and potassium levels, and the pH of our blood. It also controls our sodium levels. Without the kidney holding back sodium, we’d dry up like raisins in minutes.” The kidney is also involved in drug metabolism. This is important, particularly for people with kidney disease, which affects 2 million to 3 million people in the United States. Within that group are several hundred thousand persons with end-stage renal disease (ESRD), or renal failure, a condition that requires them to rely on dialysis to cleanse their blood. “Dialysis does not clean the blood as efficiently as the kidneys do,” says Dowling, assistant professor in the School of Pharmacy’s Pharmacokinetics/Biopharmaceutics Laboratory. “Over time, this puts a strain on the liver and its ability to break down substances.” In 2000, the WHRG awarded Dowling a $7,500 grant

to examine how ESRD affects the concentration and availability of CYP3A, an important liver enzyme, in women. CYP3A metabolizes about half of the drugs on the market, says Dowling. “If the liver can’t metabolize a drug, then its pharmaceutical activity goes on longer and the drug accumulates in the blood. This can lead to drug toxicity,” he says. Dowling theorized that women with ESRD, whose livers are challenged, are highly susceptible to side effects and may have reduced CYP3A-mediated drug metabolism compared with that of healthy women. As a result, Dowling believed, they may not completely or properly metabolize the medications they take. To test his theory, Dowling measured the women’s baseline CYP3A levels and compared them with those of controls. Then he gave both groups a drug to metabolize. Dowling found that women with ESRD had 30 percent lower activity of CYP3A enzyme than healthy controls. “What this means,” says Dowling, “is that we need to take a closer look at drug regimens in patients with ESRD, especially drugs metabolized by CYP3A. Knowing this, we can minimize drug side effects and drug interactions that ESRD patients experience.” This is especially important because ESRD patients take an average of 10 different medications, Dowling says. “At the same time, we optimize their drug therapy and improve their quality of life, which is just as important,” says Dowling, “since expected survival on dialysis, in most cases, is less than 10 years.” The next step for Dowling is to look at the full spectrum of kidney diseases, to see how they affect the liver’s many enzymes and their ability to metabolize drugs.

Pei Feng Educational programs in the oral health professions start at the core—with the basic sciences. The Dental School’s basic science department, Oral and Craniofacial Biological Sciences (OCBS), was formed eight years ago from a merger of five previously existing smaller departments, and has nearly $8 million in external funds for research. Pei Feng, MD, PhD, an associate professor in the department since 1997, has studied for 20 years the mechanisms of hormonal regulation at the molecular and cellular basis. In 1997, the WHRG awarded Feng a grant to study the estrogen regulation of cardiac TRH gene transcription in female rats. Feng hypothesized that in the female, estrogen is an important stimulatory regulator for cardiac TRH gene transcription and its encoded proteins, including TRH and TRH-related peptides. The withdrawal of estrogen caused by menopause or surgical castration may affect cardiac TRH gene expression and disturb heart function. “The grant from the WHRG was only for one year,” she says, “but it allowed me to explore an idea that I would like to continue to investigate.” Currently, Feng focuses her attention on prostate cancer research, supported by a half-million-dollar grant from the Department of Defense. Working with OCBS professors Renty Franklin, PhD, and Leslie Costello, PhD, Feng found that zinc acts as a brake on runaway prostate cancer cell growth by inducing apoptosis of prostate cancer cells. This research, Feng says, is an important project that leads to further understanding of the zinc effect on the prostatic tumorigenesis, and she is devising possible clinical applications.

The MIRACLE of Modern Medicine BY BRUCE GOLDFARB

THE EXTRAORDINARY JOURNEY OF CHRISTINE AND LOICE ONZIGA, CONJOINED TWINS SEPARATED AT THE UNIVERSITY OF MARYLAND MEDICAL CENTER IN APRIL 2002, BEGAN ON THE OTHER SIDE OF THE WORLD, MORE THAN 7,000 MILES AWAY IN THE REMOTE VILLAGE OF LEIKO IN THE KOBOKO AREA OF WESTERN UGANDA.

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Aru

The Expectant Family

Loice and Christine’s parents, Gordon and Margret Onziga, live on a farm with their four-year-old daughter, Noelle, Gordon’s parents, and his five younger siblings. The family earns about a dollar a day raising sweet potatoes, corn, and the starchy cassava root.

DEM. REP. OF THE CONGO

RWANDA

Before the separation, Christine and Loice were connected from the breastbone to the navel.

PHOTOGRAPHS COURTESY OF MARC LAYTAR, UMMC

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In October, Margret was pregnant with what the couple thought would be their second child—and planned to deliver at home. But after nearly two days of labor, exhausted and slipping into delirium, Margret was carried nearly a mile on her father’s back to the nearest taxi stand. From there, she traveled 18 miles to a hospital across the Congolese border in Aru. The hospital was unable to handle her delivery and put Margret on a bus to a hospital across the border in a town 15 miles away. Christine and Loice were delivered Oct. 28, 2001, by cesarean section, to the amazement of everybody involved— particularly their parents, who were not expecting twins, much less conjoined twins. Conjoined twins are extremely rare, occurring in about one of every 200,000 live births in the United States. About 200 pairs of conjoined twins are born annually around the world. For reasons that aren’t entirely clear, they are more common in Africa and India. The condition results when a single fertilized egg fails to separate into identical twins. Like identical twins, conjoined twins are always the same gender. About 70 percent are female. Loice and Christine were connected by tissue running from their breastbone to their navel. This condition, known as thoracopagus, is the most common form of conjoined twins. It occurs in about 35 percent of cases and almost always affects the heart. Gordon and Margret “When I first saw that Onziga hold their daughters before they were connected, I was Arua surgery. surprised,” Gordon says. “It was the first time for me to UGANDA see such babies. I had no idea they could be separated.” Kampala KENYA The Onzigas intended to return home and let the babies live out their natural lives. Lake Victoria Without surgery, about 50 percent of TANZANIA conjoined twins die before their first birthday. Because life expectancy is shorter in develop-

t is one of the most impoverished regions on earth, still recovering from strife and guerrilla warfare that wracked the country during the 1970s and 1980s. “The area that the twins are from is the poorest and most unstable area in Uganda,” says Sherri Shubin, MD, who was the girls’ pediatrician in the United States. “There’s no running water, no electricity, and no paved roads.” As a senior resident in the University of Maryland Medical Center, Shubin participated in an exchange program with the Makerere Medical School in Uganda’s capital, Kampala. The medical school’s 1,500-bed Mulago Hospital, the only teaching hospital in the country, serves a region plagued with a high infant mortality rate, malaria, measles, and diseases that thrive in crowded, unsanitary conditions. “The high incidence of acute and serious illness among children is beyond anything we see in this country,” says Cindy Howard, MD, clinical professor of pediatrics in the School of Medicine, who has supervised groups of medical students and residents since 1997. “Practicing medicine in Uganda is a great opportunity to learn how to work with limited resources. It reminds us all why we went into medicine in the first place,” says Howard. Senior residents in the exchange program spend two months at a time at Mulago Hospital working with Makerere Medical School faculty and conducting research. They are not usually involved directly in patient care. “Our primary responsibility is to help teach the residents there,” says Howard. “Mulago Hospital has a great faculty, but they are completely overSUDAN whelmed by the demand for care.”

ing nations, Loice and Christine’s chances for survival were even lower. Margret’s father said he had heard that surgery can be done to separate twins like Christine and Loice and persuaded Gordon and Margret to take the babies to Mulago Hospital, about 310 miles southeast in Kampala. Traveling to Kampala and staying in the city would be expensive. To finance their trip, the Onzigas sold nearly everything except their modest two-room house. Gordon even sold his most prized possession: his bicycle, essential for selling their crops. Together, with contributions from neighbors and relatives, the family raised about $350—more than their yearly income—to support their stay in Kampala. When the twins were 10 days old, Margret, who was still recovering from the cesarean section, and Gordon left Noelle in the care of Gordon’s parents and boarded a bus for the dusty, 10-hour ride to Kampala. It was the first time either had been to the capital city.

Fateful Encounters

In November 2001, Sherri Shubin, MD, was conducting a research project to study neonatal morbidity and mortality in the neonatal intensive care unit at Mulago Hospital. Working with Shubin and Howard was Sue Rhee, MD, then a pediatrics resident. The nursery was abuzz with talk of the “special” babies who had come from so far away. “We went to see them because conjoined twins are so rare and interesting,” she says. During their first weeks, the babies showed signs of healthy growth, but not at an equal rate. Loice, the smaller infant, was not gaining weight as rapidly as Christine, because about half of Loice’s blood supply was being shunted to her sister. Also, the position of their bodies was causing scoliosis of Loice’s spinal column. As they got older, the discrepancy in their size and weight would increase until their small bodies could no longer tolerate the stress. Gordon and Margret were devastated to learn that an

“We went over all the possibilities, from prepping the patients to where we would move them after they were separated,” says Strauch. Nearly overwhelmed by the rapid development of events that took them so far from home, the Onzigas reassured each other that they had chosen the right course. “It was a very difficult decision,” Margret says. Adds Gordon, “We told them to do the surgery because otherwise Loice and Christine couldn’t live.” The 12-hour operation took place on April 19, 2002. The first part of the surgery was led by Strauch, who began the abdominal portion, separating the liver. Anesthesia was performed by Anne Savarese, MD, assistant professor of

The 12-hour operation was performed on April 19, 2002.

operation to separate the twins was far beyond the rudimentary capabilities of Mulago Hospital and that no hospital on the continent was up to the task. Howard and Shubin had met and talked to the Onzigas, and knew their options were running out. One of the doctors at Mulago asked Howard if she would take Christine and Loice to the University of Maryland Medical Center. It was their only hope. “There was nowhere else to go,” Howard says. “If we didn’t take them, they would die.” Howard called Jay A. Perman, MD, chair of the Department of Pediatrics in the School of Medicine, and presented the case for the babies. “There weren’t resources in Africa to do the operation,” says Perman. “There weren’t even resources in Kampala to determine whether surgery was feasible.” Perman took the matter to decision-makers at the School of Medicine and the University of Maryland Medical Center, and both agreed to waive charges for the surgery. The medical center hadn’t attempted such a surgery since 1986, when pediatric surgeon J. Laurance Hill, MD, professor of surgery at the School of Medicine, led a 24-member team that separated two-month-old thoracopagus conjoined girls who shared a liver, diaphragm, chest wall, and heart sac. Those twins are now healthy 16-year-olds in Baltimore, but none of the surgeons involved in the Onziga case had ever separated conjoined twins. Hill, now chief of the division of pediatric surgery, was not directly involved in the Onziga surgery, but provided advice to the team. “Nobody has a lot of experience with these cases,” says cardiac surgeon and assistant professor Marcelo Cardarelli, MD. “If you’re lucky as a surgeon, you may be involved in one case like this in your entire life.” As a teaching case, Christine and Loice presented a

unique opportunity for the staff to work together as a large team, and to gain experience that can ultimately help other medical center patients. “What is learned in a teaching institution in caring for children like these carries over to related situations,” Perman says. “Another set of conjoined twins is probably going to be born in or near Maryland, and as a medical school I think we all—students, faculty, and patients—benefit from this experience.” “We’re a tertiary care center, and we’re supposed to teach and do complex surgery,” says Eric Strauch, MD, the assistant professor of surgery at the School of Medicine who coordinated the 35-member surgical team. “The Onzigas came to our attention, and we decided that this was something we wanted to do.” The babies arrived in Baltimore with their parents in February 2002 for extensive diagnostic imaging tests to learn about their unique internal anatomy. The babies had a fused liver and shared a diaphragm along with the breastbone and chest wall. Their hearts were twisted from their normal position and enclosed in a common sac. “We believed that we could separate them with a fair chance of survival,” says Cardarelli, “but with a 20 percent chance of them dying.” One week before the surgery, the team held a dress rehearsal in the operating room to plot the position and movement of all the principals using two life-size cloth dolls sewn together like Loice and Christine. The team had to figure out how to position the operating tables, where to place instruments, and where everybody would stand. The operating room was crowded with two of everything—two anesthesia machines, two cautery machines, two newborn warmers, and two heart-lung bypass machines.

Cardiac surgeon Marcelo Cardarelli (left) and pediatric surgeon Eric Strauch led the 35-member team that separated and cared for the girls.

PHOTOGRAPHS COURTESY OF MARC LAYTAR, UMMC

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through the connection.” With pacemakers standing by in case either girl developed an irregular cardiac rhythm, the surgeons clamped and then carefully severed the vessel connecting Loice and Christine’s hearts. Fortunately, their heart rate and blood pressure remained unchanged. By the fourth hour of surgery, the babies were completely separated. The remainder of the surgery consisted of closing the chest and abdominal wall with synthetic grafting material placed by plastic surgeon Bradley Robertson, MD, associate professor of surgery at the School of Medicine. Margret recalls the first time she saw her babies after the surgery, swaddled in bandages and deeply slumbering. Two beautiful—and separate—baby girls. “I wanted to cry,” she says. After a brief stay in the medical center’s six-bed transitional unit, Loice and Christine were cared for in the Pediatric Intensive Care Unit at the University of Maryland Hospital for Children. Once the twins were discharged from the hospital, Margret and Gordon stayed at the nearby Ronald McDonald House while the babies received physical therapy and additional medical treatment. The girls underwent physical therapy to strengthen muscles

anesthesiology and pediatrics and director of pediatric anesthesiology, and Monique Bellefleur, MD, assistant professor of anesthesiology. Once the heart and blood vessels were exposed, Cardarelli, along with Bartley Griffith, MD, chief of cardiac surgery, took the lead in untangling the girls’ circulatory systems. In case the girls experienced heart rhythm problems and needed pacemakers, Jon Love, MD, an assistant professor and director of the pediatric cardiac catheterization lab, was also in the operating room. Despite using diagnostic imaging to view internal structures before an operation, in the case of conjoined twins, surgeons don’t know what they’ll find until they’re inside. As the surgeons delved deeper, they made an alarming discovery. Loice and Christine shared a vessel that connected the upper chambers of their hearts, a finding with unknown consequences. “We knew there was blood going through the vessel from the smaller baby, Loice, to the larger baby, Christine,” says Cardarelli. “But we didn’t know what hemodynamic changes would happen if we cut the vessel. The girls also had exactly the same heart rate. We thought there may be some of the conduction system of the heart going

A final farewell for the Onziga family (front right) with some members of the surgical, pediatric, nursing, therapeutic, and nutritionist teams.

they were unable to use while conjoined, and have since reached normal developmental milestones. Loice had a small hole in her heart that was repaired by Love non-surgically last fall. According to their doctors, they have recovered well since the surgery and have an excellent prognosis. Howard attributes that positive prognosis to “the huge role played by a medical team that included medical students, residents, pediatricians, nurses, therapists, and nutritionists who have cared for the girls from start to finish.” Loice and Christine returned home to Uganda in November, shortly after their first birthday, and are expected to live normal lives. No small miracle.

ACCESS TO CARE Uninsured, underinsured, costs, language barriers—just a few of the myriad

reasons why many Americans lack

By Regina Lavette Davis

access to health care. Addressing

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this national crisis is a daunting

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Wellmobile Brings Health Care to the Underserved

task. University of Maryland professionals, however, are individually and collectively creating viable avenues for access to health care. From helping senior citizens receive affordable prescription coverage to providing dental care in rural communities, the University’s pool of talented, caring professionals are using their expertise in law, social work, and health to break down barriers across the state. “Access to Care” highlights our innovative programs, creative approaches, and superior research that strive to make health care more accessible to the people who need it most.

anet Amaya’s trips to the Governor’s Wellmobile offer two things she has found in short supply elsewhere: free health care and respect. “I had been to one clinic and the people were rude,” says Amaya, referring to how the low-cost health clinic staff often treated patients. She moved to Prince George’s County from Alexandria, Va., with her husband, Joel, and their three small children after Joel was laid off. Amaya is one of many non- or underinsured people who rely on one of the four Wellmobiles operated by the School of Nursing. The unit that serves Prince George’s County is the Central Maryland Wellmobile, which travels to Prince George’s and Montgomery counties and partners with the Anne Arundel County Health Department. According to the Agency for Healthcare Research and Quality, 44 million Americans had no health coverage in 2000. In Maryland, data from the Department of Health and Mental Hygiene (DHMH) state that one in seven Marylanders has no health coverage, and that minorities are twice as likely as whites to be uninsured. Two Wednesdays a month, the Central Maryland Wellmobile parks outside Bladensburg Elementary from 1 to 7 p.m. Clients at this site are mainly uninsured Latinos. When the unit arrives, patients are on time, waiting for their appointments. According to Mary Dunlavey, FNP, a School of Nursing clinical instructor

and a Wellmobile nurse practitioner, the Bladensburg site is one of the busiest in the Central Maryland rotation, which also includes Deerfield Run, Langley Park McCormick, and Coolspring elementary schools. On any given day, there is never a lull, and no time for breaks for the staff. After each patient registers with Nohemy Munoz, an intake coordinator and English/Spanish translator for Dunlavey, they are seen by Brenda M. Vitello, RN, BSN. She checks their vital signs, determines their chief complaints, and takes lab samples (such as blood and urine) when necessary, before sending patients to a second examining room for their encounter with Dunlavey. Each of the two examining rooms is just long enough to fit an examining table. Despite the small area, the medical professionals are able to provide the care that their patients need. In addition to stethoscopes and blood pressure monitors, the rooms are equipped with refrigerators to store lab samples and storage cabinets for supplies and charts, and an EKG machine. In Vitello’s area there’s a laptop computer, which she uses to track patient data. She says that most patients do come back for follow-up appointments, unless they find a doctor or move. “People who have multiple or serious health issues are often referred to low-cost clinics,” she adds. However, Vitello says that some patients will not always go to clinics, and end up return-

high prescription

ing to the Wellmobile. The reasons she cites mirror those found in the health care literature on access issues for lowincome populations: transportation, knowledge of where the clinic is located, and inability to pay even modest fees. Despite the care the Wellmobile offers, Vitello acknowledges its limitations. “If somebody has a lot of complex health problems, such as diabetes, it’s not a good idea for us to be their primary source of care,” she says. “We refer them to other providers when that is the case.” Marla Oros, MS, RN, School of Nursing associate dean for clinical and external affairs, says that the mobile units may be the first and last health care stop for many people. “Originally, we simply visited community sites with the Wellmobile and referred patients to more permanent medical care, rather than becoming a ‘modified provider’ of services. That was only a ‘Band-Aid’ approach to providing services to folks who won’t ever make it to the providers due to all of the access-to-care barriers that they have,” she says. About a yard away from Vitello’s room, Dunlavey deals with more than just patients’ chief health complaints. Often, she says, they arrive because of a particular ailment or concern that masks other issues, such as mental health problems, domestic crises, or concerns about sexually transmitted diseases. Like that of any skilled medical professional, Dunlavey’s role requires her to practice nursing and medicine—to be a compassionate, concerned listener, as well as to treat and manage illness. Dunlavey used these skills with Amaya, whose blood pressure was slightly elevated. After a probing question or two from the nurse practitioner, Amaya shared a concern she had about her 5-year-old son, who was suffering from an unexplained, undiagnosed skin lesion that was increasing in size and causing him pain

Brenda Vitello and Mary Dunlavey care for under- and uninsured patients.

and discomfort. He couldn’t get a diagnosis and treatment, partly because of his low-income health insurance. Dunlavey has seen cases like this before. “This is what we experience a lot,” she says, recognizing that Amaya’s problem may relate to her race as much as her income. “If I, as a non-minority, were to go [to a clinic] with my child, the response may be different.” Dunlavey’s concerns are consistent with information from the Maryland DHMH, which issued the Maryland Health Improvement Plan 2000–2010. The plan reports that there are many

pockets of underserved populations across the state that lack access to willing providers of primary and specialty care, and that a “lack of cultural competence on the part of providers” is a barrier to access to health care for some Marylanders. Unlike Amaya, who was born in Clay, Minn., most of the patients at this site are immigrants and are scheduled through the Wellmobile’s collaboration with Catholic Charities. Olga Mata, a family specialist for Catholic Charities and a parent-teacher liaison for the Prince George’s County

A School of Nursing Outreach

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Board of Education, sets the appointments and knows firsthand how the Wellmobile has helped the community. “I’m very pleased with their services,” says Mata. “I enjoy working with the Wellmobile staff. I wish the Wellmobile could come more often— at least every week,” she adds. It costs approximately $250,000 a year to operate one Wellmobile. The School receives $200,000 per year from the state to operate the Central Maryland Wellmobile and $600,000 a year (for the next eight years) from the Connect Maryland foundation to operate the other three vans. Oros cites additional sources of support. “We supplement these funds with support from the Maryland Department of Health and Mental Hygiene. Medicaid provides matching federal funds to our state funds for the vans to perform outreach and enroll families in the

Maryland Children’s Health Program. We also have other small grants from foundations,” she says. Appreciation of the Wellmobile efforts extends beyond patients and partnership staff to members of the community. Carol Ann North, a summer school teacher at Bladensburg Elementary, was glad to see the van. “It’s great that the state and the University are stepping up health care for the poor and the marginalized,” she says. North describes the Wellmobile as a “proactive measure to help get medical problems corrected now.” Oros attributes the success of the Wellmobile to its network of partnerships, teamwork, and dedication. “We have an amazing network of local health departments, community health centers, health care providers, and community organizations that provide health care access to vulnerable families.”

The Governor’s Wellmobile Program is one of the School of Nursing’s many outreach initiatives. Others include: • Fifteen school-based wellness centers in Baltimore and Harford counties and on the Eastern Shore. • The Open Gates Health Center, which meets the health care needs of uninsured and underserved populations in Baltimore’s Pigtown/Washington Village community. • The Pediatric Ambulatory Care Center, a walk-in clinic located on the first floor of the School of Nursing, which is a collaborative, interdisciplinary effort among the schools of nursing, medicine, social work, and pharmacy. • The Southwestern Family Support Center, which teaches pregnant and parenting teenagers at Southwestern High School strategies for selfreliance and productivity. • Healthy Childcare Maryland, a nurse consultation and training program for licensed child care providers in Prince George’s and Frederick counties.

Substance-Abuse Prevention Initiatives Improving Professionals’ Intervention Skills wo University of Maryland initiatives, the Tobacco Intervention Program, funded by the State of Maryland through the Baltimore City Health Department, and Project Mainstream, funded by t h e A s s o c i a t i o n f o r Me d i c a l Education and Research in Substance Abuse (AMERSA), focus on improving the substance-abuse intervention skills of University students, faculty, and clinicians. “Tobacco dependence is a chronic, progressive, relapsing brain disease,” Jacquelyn L. Fried, MS, associate professor in the Dental School, tells participants attending her tobacco-use cessation and information workshop titled “How to Help Your Patients Be Tobacco Free.” “Smoking cessation requires ongoing intervention from health care professionals. That’s where you come in. As health care profes-

sionals, the messages you give your patients are important and respected.” Fried is the principal investigator on a grant from the Baltimore City Health Department to train health care professionals in tobacco use prevention and cessation interventions. Anthony Tommasello, PhD, associate professor in the School of Pharmacy and director of the School’s Office of Substance Abuse Studies, and Nalini Jairath, PhD, associate professor in the School of Nursing, are co-investigators. The grant came out of the state of Maryland’s Tobacco Restitution Fund. Fried and her team partnered with the University of Maryland Medical Center last spring to create workshops to make health care providers better tobacco-use interventionists. “Studies have shown that health care providers who receive formal training in tobacco use cessation are more apt to screen for

tobacco use and appropriately intervene with their tobacco-using patients,” comments Tommasello, who also conducted the workshops. Workshop participants, who represented a range of health care fields, learned science-based intervention guidelines endorsed by the Agency for Healthcare Research and Quality (AHRQ), which focus on behavioral change and modification and pharmacological management of nicotine dependence, says Tommasello. Those guidelines include the Five A’s: Ask, Advise, Assess, Assist, and Arrange. Workshop participants were trained to ask patients about their current smoking status, advise smokers to quit, assess their willingness to quit within 30 days, assist those willing to quit, and arrange follow-up counseling. “Seventy to 90 percent of smokers say they want to quit,” says Fried, a

former smoker. “We need to help them. Our compassion and commitment can help reduce the morbidity and mortality associated with tobacco use.” The second campus substance-abuse initiative is also run by an interdisciplinary team that wants to make sure faculty, staff, and students know how to recognize substance abuse. This team, which is mentored by Tommasello, consists of Ed Pecukonis, PhD, associate professor in the School of Social Work; Marla Oros, MS, RN, associate dean for clinical and external affairs in the School of Nursing; and Virginia Keane, MD, associate professor of pediatrics in the School of Medicine. “The focus of our project is on both faculty development and curriculum enhancement,” says Oros. “Our goal is to get substance abuse screening, assessment, and treatment into the core curriculum across the disciplines, adding courses where necessary.” Until recently, most substance-abuse recognition and intervention courses were designed for students who will specialize in substance-abuse treatment. The team wants training for all health

Tobacco is as addictive as heroin and cocaine, kills 435,000 adult users in the United States every year, and costs the U.S. more than $80 billion annually.

care students, not just those who will specialize in that field. “We conducted a faculty assessment across the schools of pharmacy, nursing, medicine, and social work,” says Oros. “It confirmed that faculty wanted to increase their knowledge to more effectively practice or teach substance-abuse screening, assessment, brief intervention, referral to treatment, and prevention.” Based on this assessment, the

team launched several faculty development initiatives, including a three-hour substance-abuse recognition seminar. “We are developing a Web-based course that will expand the workshop,” says Oros. “We plan to pilot the workshop for faculty first and then adapt it for students as an elective.” The team has made strides in changing the curriculum, says Oros. “We incorporated substance abuse content into the orientation for all social work students. This content is now a permanent agenda item for the orientation.” Oros says that the content will be added to the beginning assessment course for family nurse practitioner students. Several area health departments also approached the team and community health centers to deliver the workshop for their primary care providers over the next year. “We have made much progress in the first year of our fellowship, especially in institutionalizing the content in primary care training, and we look forward to expanding the training, both on campus and in the community,” says Oros.

MouthPower Teaches Girls the Dangers of Tobacco Use

hildren need to learn when they are young that tobacco is dangerous. The Dr. Samuel D. Harris National Museum of Dentistry’s MouthPower patch program teaches Brownies and Junior Girl Scouts the pitfalls of tobacco use and the importance of oral hygiene. Brownies and Junior Girls Scouts visit the museum and complete several interactive healthy habit learning stations. The “Mr. Gross Mouth” station teaches the girls about the oral health conditions caused by cigarettes and smokeless tobacco. Visiting the interactive exhibit “The Marvelous Mouth” teaches the girls about tooth anatomy and careers in dentistry. “One of our primary goals is for MouthPower to become a national program for the Girl Scouts of the USA,” says Janis Goldman, director of education and public programs for the National Museum of Dentistry, who expects the program to launch nationally by 2005. This will include a Web-based program to be implemented this year that will allow Girl Scouts from around the country to complete the MouthPower program requirements remotely. MouthPower was developed to help address the epidemic of smoking-related deaths in women and high

smoking rates among teenage girls. According to the U.S. Surgeon General, women account for 40 percent of tobacco-related deaths— about twice the percentage recorded in 1965. The 2002-2003 MouthPower program is sponsored by Oral-B Laboratories and the Web site version is made possible through the generous support of Dr. Samuel D. Harris. The Dr. Samuel D. Harris National Museum of Dentistry, an affiliate of the Smithsonian Institution and the University of Maryland, celebrates the great heritage of dentistry, its present, and its future. The Museum’s historical artifacts, interactive exhibitions, and engaging programs expand public awareness of the importance of oral health. For additional information, call 410-706-0600 or visit www.dentalmuseum.org.

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Social Work Is Good Medicine for Cancer Survivors By Myra A. Thomas

n Carl Jung’s book Modern Man in Search of a Soul, the noted psychiatrist and guru of modern psychoanalysis states, “The distinction between mind and body is an artificial dichotomy, a discrimination which is unquestionably based far more on the peculiarity of intellectual understanding than on the nature of things.” Today, however, as researchers discover a direct link between emotional and physical health, the role of social workers in the treatment of life-threatening illnesses is fast becoming essential. Julianne S. Oktay, PhD, a professor and director of the doctoral program in the School of Social Work, admits, “The health care system has, at times, bifurcated the body and mind.” In her research on the role of social work in breast cancer treatment, for example, she has witnessed the benefits of a strong psychosocial support system for patients and their families firsthand. Oktay notes landmark findings from Stanford University, which investigated the health benefits of support groups for advanced breast cancer patients. “It was found that people in support groups lived almost twice as long as those who did not participate in a support group,” she says. Despite the benefits associated with social work in the clinical diagnosis and treatment of disease, access to a professional is not always that easy. Jesse J. Harris, PhD, dean of the School of Social Work, adds, “Often, the role social workers can play is not fully understood by the medical profession.” “Social workers, for example, can assist survivors and their families in dealing with myriad psychosocial issues and are equipped to link families and survivors with other valuable resources,” he says.

Additionally, the nature of health care has changed the way that patients receive social work services. “There was a time when social work services were primarily tied to the hospital inpatients, where the social worker provided counseling,” says Oktay. As more procedures are performed on an outpatient basis (including many treatments for cancer), linking the social worker to the patient

Baltimore County resident notes that the network of counselors and other cancer survivors at the organization have helped her to deal with the diagnosis. “They were able to point me in the right direction, as far as information on the disease, and to connect me with others in the same situation,” she says. At the sessions, cancer survivors seek out other survivors to vent their anxiety and fears of a worsening prognosis. Additionally, Sonntag’s parents and sister have attended support sessions for family members of cancer survivors. “They can say things to the support group that they can’t say to me,” she admits. Oktay says that the way to get cancer survivors to access social workers may involve explaining how the services will be helpful to the family. In her 1991 book, Breast Cancer in the Life Course: Women’s Experiences, she

who provide support group services and counseling sessions. As well, there are now more community-based support networks available, including The Wellness Community in Towson, created specifically for the emotional needs of cancer patients. The Wellness Community provides free professional support services for cancer patients and their families, led by licensed psychotherapists and staffed primarily by social workers. Oktay serves on the professional advisory board for the nonprofit organization. However, some cancer survivors may still refuse the help available because of the stigma they feel is associ-

Julianne Oktay says psychosocial support is important for cancer patients and their families.

becomes much more difficult. Fortunately, some medical facilities are developing multidisciplinary approaches to social work and disease treatment. For example, in the Breast Evaluation and Treatment Program at the Greenebaum Cancer Center, a component of the University of Maryland Medical System, patients are referred to a number of doctors, including medical, surgical, and radiation oncologists. But the patients can also receive referrals to a network of psychotherapists and social workers

ated with psychosocial services. “They may imagine that the only one needing a social worker is someone who is poor,” says Oktay. “Also, many women still feel embarrassed about any type of mental health problem, even when it is related to a life-threatening illness. Another factor is a denial process that occurs early in the disease,” she says. Dawn Sonntag received her diagnosis of breast cancer in 1994 and soon after began weekly group support sessions at The Wellness Community. The 35-year-old accountant and

PHOTOGRAPHS BY TRACY BOYD

found “just how quickly these women moved from concern about the diagnosis to concern about how this was going to affect their family. Often, people get into services because they recognize that it will benefit their family members. The family is a great motivator.” Understanding how the families of cancer patients tick has led Oktay to shift the focus of her research somewhat. As the recipient of a $150,000

research grant from the National Cancer Institute, Oktay studied the life experiences of women whose mothers had early onset of breast cancer— before age 50. Because breast cancer can have a strong hereditary link, the daughters of breast cancer patients often become prime candidates for genetic testing. Of the 41 women involved in Oktay’s research, approximately twothirds had mothers who died from the illness. The women, ranging in age from about 19 years old to their early 50s, had “a lot of buried and unresolved feelings, often that they were not able to previously express or resolve,” says Oktay.

receiving statistical information on disease probability, and ultimately, test results from the laboratory. Miriam G. Blitzer, PhD, chief of the Division of Human Genetics at the School of Medicine and a professor in the Department of Pediatrics, understands the need to meld medical diagnoses and psychosocial services. Blitzer will work on a joint research project with Oktay this fall, specifically focusing on the experience of families of breast cancer patients and those at risk for breast cancer as these women receive genetic counseling. “There are often social and family issues going on that affect how daughters of breast cancer survivors

The research interviews will be the basis of Oktay’s upcoming book, published by Haworth Press, tentatively titled The Other Breast Cancer Survivors: Daughters’ Stories, which should be available this year. Concerning her research interviews, Oktay adds, “I came away from the study with the knowledge that there is a great need for more bereavement services for these women. As far as the genetic counseling, there is a need for a team approach, as the experience can be dispassionate.” Genetic counseling traditionally involves the patient

process the information from a genetic counselor, and ultimately how they act on that information. There is a need for professionals to learn and to better impart these important services,” says Blitzer. She adds, “This cross-pollenization between disciplines is important, and we have professor Oktay here to push the research and collaboration between medicine and social work further.” Through such efforts, social work specialists are able to provide lasting benefits to cancer survivors and their families.

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Treadmill training helps stroke patients improve balance, leg strength, and walking capability.

New Hope for Stroke Victims By Rosalia Scalia University researchers are offering stroke victims access to new treatments that may help them return to active lifestyles.

troke is the leading cause of adult disability in the United States, affecting 750,000 people each year and leaving half a million of them with paralysis, weakness, and other debilitating effects. For many older adults, a stroke limits their ability to use their legs, hands, and arms; increases their risk of falling; and leads to a sedentary lifestyle. This inactivity may worsen conditions such as heart disease and diabetes, and may even lead to another stroke. Traditional stroke rehabilitation therapy lasts only a short time because most functional recovery tends to plateau after three months. However, University researchers at the Geriatric Research, Education and Clinical Center (GRECC) are challenging that time frame for recovery. With a fiveyear, $7.5 million grant from the National Institute on Aging, National Institutes of Health, Richard F. Macko, MD, associate professor of neurology and director of the GRECC’s stroke program, is testing two new therapies.

He is working with a team of geriatricians, nurses, exercise physiologists, physical therapists, and neuroscientists. “Evidence from our initial studies indicates that even individuals whose strokes occurred many years ago can benefit from structured exercise that promotes the ‘re-learning’ of basic movement skills that are useful in everyday life,” says Macko. “We are exploring a new model of stroke recovery in which repetitive motion forces people who have had strokes to use their paralyzed limbs. This prompts areas in the nondamaged portion of the brain to take over some of the functions lost as a result of the stroke.” In one study, participants with partial paralysis that affects their ability to walk are using specially calibrated treadmills that go as slowly as .1 mile per hour. The exercise retrains their legs and rewires critical pathways in their brains. Preliminary research shows that stroke patients who have already completed all conventional rehabilitation therapy can benefit from the additional

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exercise training on the treadmill, gaining improved leg strength, balance, and walking capability. “Of course, progress is variable, depending on the patients and their level of disability,” says Macko. “But the link between exercise and recovery is unmistakable.” The exercise often has another positive outcome. “Treadmill training increases fitness levels, and aerobic exercise has the potential to improve cardiovascular health, which governs long-term health outcomes,” adds Macko. Participants in the study are experiencing the benefits of exercise. After two months of treadmill training three times a week for 30 minutes, Leonard Thomasos says he feels stronger, no longer needs his cane, and is motivated to exercise more. “Even on my off days, I try to walk and do exercise. I use an ab roller and do some squats,” he says. Anonn York, another study participant, has seen similar gains. “The only reason I use my cane now is to get a seat on the bus faster,” he jokes. A second GRECC study, headed by Jill Whitall, PhD, associate professor of physical therapy, focuses on 72 patients whose arms have been weakened by strokes. Study participants exercise their arms on a machine designed by Whitall and Sandra McCombe-Waller, MS, PT, NCS, assistant professor of physical therapy. Seated at a table, holding the handles on the bilateral arm trainer in front of them, participants extend one arm forward, keeping the other arm close to their body. Following the sound of a rhythmic auditory cue, participants alternate pushing one arm out and pulling the other arm in. The therapy lasts for six weeks, and the results will be compared with that of participants doing six weeks of conventional therapy. Whitall and other researchers on the project think the training will improve motor control, strength, and range of motion. If the

bilateral arm trainer produces good results, it could one day be used in community and home-based settings. “The results are preliminary but encouraging,” says Whitall. “Even those with quite limited ability to use their weak arm have found this training to improve some aspects of motor function.” Both stroke rehabilitation studies at the GRECC use advances in imaging to assess how the brain is affected by the repetitive exercise. In the treadmill study, Macko is using transcranial magnetic stimulation (TMS) to stimulate the brain and determine the strength of the message sent to the paralyzed or weakened leg. “This non-

appear to be “rewired.” Macko and Whitall will also find out if study participants are continuing to exercise. “Since older adults tend to be more sedentary before the stroke, it’s especially challenging to motivate them to exercise,” says Marianne Shaughnessy, PhD, assistant professor in the School of Nursing and a GRECC researcher whose work focuses on identifying barriers to exercise and designing regimens to overcome them. “The trick is getting them to stick with a program long enough to see a result, whether that’s increased endurance, better balance, or improved sleep, mood, and sense of well-being,”

Bilateral arm training is aimed at improving strength, motor control, and range of motion.

invasive method provides evidence that as little as 20 minutes of treadmill exercise can increase the signal to the paralyzed muscles,” says Macko. “Our ongoing research will determine whether six months of treadmill exercise training produces sustained improvements in the muscle and the brain that lead to long-term gains in the function of stroke survivors.” Whitall’s bilateral arm study uses TMS and functional magnetic resonance imaging (fMRI) to show changes in brain-activation patterns during arm movements. Six months after the conclusion of the arm training, Whitall will assess the physical abilities of the study participants and determine if their brains indeed

“The link between exercise and recovery is unmistakable.”

says Shaughnessy. “Once older adults realize the benefits of exercise, they are hooked, as Dr. Macko’s study subjects are.” The dual stroke studies represent just one of many research projects conducted at the Geriatric Research, Education and Clinical Center. The GRECC plays a vital role in increasing basic knowledge of the aging process and diseases associated with it. The faculty and staff serve as a resource for research, clinical, and educational activities, all aimed at preventing and reversing declines connected to aging and sedentary lifestyles.

A C C E

Rx Savings for Seniors

Throughout Baltimore, the Peter Lamy Center for Drug Therapy and

and Aging and the regional retail pharmacy branch of NeighborCare. The partnership is funded by a $7,000 School of Pharmacy interdepartmental grant. Layson-Wolf is the principal investigator, and Nicole Brandt, PharmD, CGP, director of clinical and educational programs at the Lamy Center, is co-principal investigator. It supports a pilot project to characterize those who seek these types of pharmacy assistance programs and

Aging is signing up seniors for savings on prescription medicines.

By Eric Brosch

MARYLAND OF

UNIVERSITY

t’s 8 a.m. and senior citizens begin to arrive at a north Baltimore senior center. They are not there for yoga or tai chi or a game of bridge. They have come from across the city looking for the same thing as seniors around the countr y— help with the cost of prescription medicine. As the four-person team from the School of Pharmacy and NeighborCare Professional Pharmacies set up tables, Mary Swem, a program coordinator at the center, hands Shirley Craig, RN, BSN, the medicine list of an elderly woman who Shin W. Kim checks a senior’s blood pressure. couldn’t come in that day. Craig looks it over, grimaces, and sighs. “Would you look at that?” she “Sometimes the cost of their drugs is asks no one in particular. so high, I don’t even want to tally them On the bottom of the form, where up,” she says. seniors are asked to list the medicines Craig calls over Assistant Professor they take, she has written in 21 Cherokee Layson-Wolf, PharmD, to prescription and over-the-counter discuss what they can do for this drugs: inhalers, antibiotics, ophthalmic woman. She has prescription coverage, solutions, heart and gout medicines, but it isn’t much help. Her plan charges and over-the-counter vitamins. The a $10 co-pay for each medication— woman who filled out the form is in with a yearly $1,000 limit. Adding up her early 70s and lives in northeast the costs of the woman’s medication Baltimore on just under $1,200 a regimen in her head, Craig estimates month in Social Security and disability that this woman had reached that limit compensation. Some of the prescrip- after three or so months, leaving her tions are to be taken only as needed, without coverage for the rest of the year. says Craig, but there is still a substantial Unfortunately, because she has some upfront cost to buy them and have prescription coverage, the woman is them on hand. disqualified for the discount prescrip-

Shin W. Kim (left) and Cherokee Layson-Wolf help a senior sign up for discount prescription cards.

tion drug cards seniors are signing up for at the center. Although this senior does not qualify for the discount cards, LaysonWolf is still able to review the woman’s medications for contraindications and other problems. Through the rest of the morning, Layson-Wolf, Craig, and fourth-year pharmacy students Shin W. Kim and Ann Nguyen meet with a dozen or so seniors. They check their blood pressure, review their medications, and sign up those who qualify for the discount drug cards. The program is called Rx Savings for Seniors. It’s a partnership between the pharmacy school’s Peter Lamy Center for Drug Therapy

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materials and sign up seniors for the discount drug cards. The cards are meant to offer some financial assistance to low-income seniors, but the cards have their limitations. Each has an annual income cap, as low as $18,000 for individuals, and offers varying discounts and co-pays on only some of a company’s brand-name medicines. Often, seniors must sign up for multiple cards because each drug company may offer its own.

how participants in such programs perceive the benefit of the prescription cards. The grant pays for data collection, materials, and travel expenses for the investigators to visit centers and sign up seniors for prescription discount cards offered by the major pharmaceutical companies. The project is one of many that fulfill the Lamy Center’s mission to improve drug therapy for aging adults through research, education, and clinical initiatives. Pharmacists and students from the center also provide outreach services at senior housing centers through a $76,000 contract with the Baltimore Commission on Aging and Retirement Education. That program includes medicine reviews, “Eating Together” lunchtime educational sessions that cover disease states, and a train-the-trainer program to teach housing center staff to identify medication-related issues. The Lamy Center staff also attends health fairs, where they distribute educational

“Pharmacists are frustrated and patients are confused. There should be just one card,” says Layson-Wolf. What the discount cards don’t offer is a long-term solution. That is one point on which the pharmaceutical companies, politicians, and LaysonWolf all agree. “This is a stopgap measure,” says Layson-Wolf. “It’s about providing more access for seniors, especially those who don’t have the income to afford prescriptions on a regular basis.” Until the federal government passes a senior drug card plan, Layson-Wolf intends to bring what financial relief she

can to as many seniors as possible. “Sometimes these forms are just sitting on the counter at a pharmacy,” she adds, “and no one thinks to pick them up.” Communication is important, says Craig. “Most elderly don’t seek out help,” she says. “They don’t think to tell their pharmacist that a medication is too expensive. It’s not uncommon for them to avoid taking medicines because of the expense.” Helping them fill out the forms is important, too. “It’s easy to accidentally omit a number or a signature,” says Layson-Wolf. “Many forms are rejected by the companies because they are incomplete.” For that reason, the Rx Savings for Seniors program has a research component, too. Students involved with the program follow up with seniors to determine if they received their cards in the mail and if they are able to use them. One senior with good news is Annie. She lists only one medication—for high blood pressure—on the form that Craig reviews. And she meets the income requirement for that pharmaceutical company’s card. Just in case her doctor prescribes a new medication, Craig has her apply for every card available. Craig looks over the form, and Annie asks how much money she’ll save with the card. She pays $68 a month now, out of pocket. Craig looks up Annie’s medication in a three-ring binder, and tells her the good news: Once she gets her card in the mail, her blood pressure medicine will cost her only a $15 a month co-pay. It may seem like a small savings, but Annie is grateful for it. Still, pharmacists and seniors are waiting for a permanent solution to the high cost of medicines. “We don’t know what the lifespan of these cards will be,” says LaysonWolf. “It all depends on when the federal government passes a prescription drug benefit for seniors.” Until then, she says, the discount cards will have to do.

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Dental Fellows Bring Care to the Needy By Jim Duffy

andy hadn’t had much luck with dentists. Five years ago, when her then 8-year-old daughter needed caps on nearly all of her front teeth, the Hagerstown, Md., woman couldn’t find a provider in her Western Maryland area who would accept Medicaid. Sandy scrambled to come up with as much money as she could, but in the end, could only afford to fix half of Amy’s teeth. “That was really rotten, the way my child had to suffer because I didn’t have the money,” recalls Sandy, who has four children of her own and three stepchildren. “She was so embarrassed about the way her teeth looked that she didn’t even want to go to school.” While attending dental school in her native Philippines, Via Cuisia, DDS, never imagined that such cases could be so common in the United

States. “I thought that I shouldn’t go to work in the States after graduating because nobody there has cavities,” she recalls. “Coming from a developing country, I was thinking that there must be a lot more tooth decay in the Philippines.” Since signing on as a pediatric dental fellow with the Dental School, Cuisia (pronounced KWI-SHA) has been learning just how naive her assumption was. For the past two years, she has been practicing four days a week in a two-chair clinic at the H.W. Murphy Community Health Center in Hagerstown. Cuisia is the only pediatric dentist in the area who accepts Medicaid payments; in fact, the center only accepts patients from low-income families. Cuisia is one of four Dental School fellows practicing in community clinics in rural areas of central and western Maryland. The three-year-old fellowship program is a cooperative effort of the Dental School, the state’s Department of Health and Mental Hygiene (DHMH), and local health organizations to ease the plight lowincome Marylanders face getting dental care for their children.

The fellowship program marks a significant shift in the Dental School’s commitment to community outreach. The School has long served Medicaid patients out of its campus clinic, but the fellowship program enables it to respond to needs in distant Maryland communities. With Medicaid reimbursement rates at less than 50 percent of standard billings, many Maryland dentists refuse to see Medicaid patients. Those who do see underserved children are most likely to be general dentists who often won’t treat patients under age 5. Pediatric dentists are in especially short supply in rural areas, so poor families often have nowhere to turn. “It’s a double whammy,” says Harry S. Goodman, DMD, MPH, associate professor of pediatric dentistry in the Dental School and a former director of the DHMH’s Office of Oral Health. “The kids who are poor are in greater need, and it’s these same kids who don’t have access to dental care.” A 1996 Dental School survey found that 70 percent of tooth decay among Maryland’s low-income children goes untreated and that fewer than one in five children enrolled in Maryland’s

PHOTOGRAPHS BY JUSTIN STEELE

UNIVERSITY

Via Cuisia, a dental fellow from the Philippines, was surprised by the level of tooth decay in the United States.

to see Cuisia in Hagerstown reached Washington County Hospital, but the nearly 500, and the Murphy Center other UM dental fellows are working at had to temporarily stop accepting new clinics operated by county health patients. The clinics in Allegany and departments. Under a complex fundCarroll counties maintain lengthy ing arrangement, the local organization waiting lists as well. pays the Dental School an amount Sandy found her way to the roughly equivalent to the fellow’s salary. Murphy Center shortly after Cuisia The School then puts the fellow on its payroll, while the local organization recoups its expenses through Medicaid reimbursements. “ E v e r y b o d y ’s balance is supposed to be zero in the end,” Goodman says. “In reality, we all probably lose a little money,” Tinanoff concedes. “But we’re all willing to lose a little money on a program that helps Via Cuisia examines a child’s teeth in the Hagerstown clinic. this many people.” Clinics staffed for a year or longer by arrived in Hagerstown. Cuisia has now fellows in Allegany, Carroll, and treated all seven of Sandy’s children. For Washington counties book between the most part, the care has involved 1,000 and 1,500 appointments apiece cavities and cleanings, but one child per year. In early 2002, the waiting list needed a root canal, and the clinic helped another find orthodontic care. Dental Clinics Enable Access to Care “I can’t even imagine having to pay for all the work they’ve done,” Sandy hrough programs uniquely designed to meet their needs, patients at the says. “If we had only one or two Dental School have access to comprehensive oral health care. This care is children in the house, it might be provided to a wide range of patients including those who are homeless, loweasier, but when you’ve got seven it’s income, uninsured and underinsured, and physically and mentally disabled. really tough.” In addition, the Dental School’s clinical programs include the Special Patient The experience of Sandy’s family is Care Clinic and the PLUS Clinic that provide care to unique population groups. not unique. “This fellowship program The Special Patient Care Clinic provides care to those with mental and physical has been such a benefit to children in disabilities, while the PLUS Clinic serves people living with HIV. Students who our community,” says Kim Murdaugh, are supervised by faculty provide all patient treatment. director of community health In FY 2002, the Dental Schools’ pre- and postdoctoral clinics treated 34,839 programs for Washington County patients from as far away as Delaware, Virginia, and Pennsylvania. Hospital. “The families are very happy Along with payment plans, a small amount of financial assistance is available with the care they’re getting, and the for patients unable to afford the School’s already-reduced fees. The Dental fellows we’ve had have been absolutely School’s Quest for Care Program, founded in 1985 and run by dental students, wonderful.” helps selected patients in need obtain necessary dental treatment. The Quest Murdaugh estimates that a third of for Care program is funded through student events and two endowments: the the dental patients at the Murphy Quest for Care Fund and the Robert Fishman Memorial Fund. Center have never seen a dentist “The patients who benefit from Quest for Care must fit income eligibility before. Cuisia says that although that criteria, and their needs are addressed on a case-by-case basis,” says Jane Atkinson, DDS, assistant dean for clinical affairs, and a professor in the number is telling, it doesn’t give a Department of Oral Medicine and Diagnostic Sciences. complete picture of the dental care

Medicaid program sees a dentist annually. Obviously, such scant care can have dire effects on a child’s oral health. It can also hinder educational and emotional development. “When kids have cavities that go untreated, those cavities are going to infect the tooth’s nerve,” says Norman Tinanoff, DDS, chair of the Department of Pediatric Dentistry. “That means pain, and associated with that pain is an abscess. Those children are going to be sick children. That pain needs to be resolved before they can concentrate properly and do well in school. And they aren’t going to be laughing, eating, drinking, and socializing the way they should.” Cuisia has seen firsthand the transformation that long-overdue dental care can spark. “Some patients, when they first come here, are not eating well and are really skinny,” she says. “When they come back after their treatments for another appointment, they’ve gained weight, and their parents are talking about how much happier their child is.” Cuisia’s fellowship slot in the Murphy Center is operated by

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needs in places like Washington County. “We’ve had 18-year-olds come in who’ve never been to a dentist—ever,” she says. Tinanoff hopes to expand the program from five to as many as 10 slots by placing fellows at clinics in Southern Maryland and on the Eastern Shore. Once that’s done, a version of the program might be tailored for urban areas of Baltimore City. Attracting top-notch fellows has been a challenge, Tinanoff concedes, but he’s hopeful that the program will get a boost in 2003 from the Maryland General Assembly in the form of a bill that would allow foreign-trained dentists who complete two years of service in [Maryland] community clinics through the fellowship program to be eligible for licensure in Maryland. Currently, only dentists trained at U.S. schools can take the Maryland licensing exam. “If we can grow this program to the level we want, that would take a lot of

Michele Foster (left) instructs Jasmine Jones on the proper use of an inhaler.

Breathmobile Brings Asthma and Allergy Relief

“This fellowship

By Rosalia Scalia

program has been such a benefit to children in our community.”

pressure off of a system that’s really broken right now,” Tinanoff says. Cuisia, who completed her residency at Louisiana State University before signing on as a fellow, regards her experience in the program as invaluable preparation for her future career. “During a residency, you’re responsible for treating patients, but you still feel like a student,” she says. “Here, it’s more like a real private practice. It’s a great training ground.”

asmine, a 13-year-old Baltimore City public school student, spends about 20 minutes of her school day aboard the Breathmobile, the first mobile clinic on the East Coast dedicated to treating asthma and allergies. She draws in a deep breath from her inhaler, exhales, and breathes in again. As she practices, she learns that she has to coordinate her breathing to effectively deliver the medicine to her lungs. Using the device properly will help her get the correct amount of medicine into her system to relieve her asthma symptoms. Launched in March 2002, the Breathmobile has a caseload of more than 200 students, but that is just the beginning, says Carol J. Blaisdell, MD, associate professor of pediatrics at the School of Medicine. She envisions

bringing comprehensive asthma health care and education to 600 children at Head Start programs and public schools throughout Baltimore. “Asthma is the number one reason for pediatric emergency room visits and t h e l e a d i n g c a u s e o f school absenteeism,” says Blaisdell, who is also chief of the pediatric pulmonology and allergy division at the University of Maryland Hospital for Children. “Children in urban environments are at higher risk for asthma attacks, which makes the Breathmobile an important tool in keeping Baltimore City children healthy.” The program complements care provided by area physicians. “Asthma specialists have long had a record of providing care that leads to improved outcomes,” says Blaisdell, noting that

PHOTOGRAPHS BY TRACY BOYD

rooms, a testing area, and a waiting the Breathmobile staff sends a area, and can accommodate two summary of each visit, with recompatients and four Breathmobile team mendations, to patients’ primary members in its small but efficient care physicians. By bringing care quarters. The custom-built clinic is to children in their communities, says equipped to evaluate the presence and Blaisdell, the Breathmobile staff hopes extent of obstructive lung disease, test to improve access to consistent for environmental allergies, and propreventive asthma care. vide asthma education for patients and To identify potential patients, their families. It also has a computerBlaisdell and Mary Beth Bollinger, ized charting system that maintains DO, assistant professor of pediatrics patient information. and director of allergy at the University Four physicians—Blaisdell, Schwindt, of Maryland Hospital for Children, Bollinger, and Maya Ramagopal, MD, worked with officials at the Baltimore assistant professor of pediatrics—rotate City Health Department and at the time on the vehicle. In addition, Baltimore City Public School System in Breathmobile coordinator Sharon 2000. With the help of school nurses Irving, PNP, and pediatric nurse and health aides, they conducted a survey that revealed asthma prevalence rates as high as 10 to 20 percent. “The average prevalence rate nationally is 7.4 percent. The average for Maryland is slightly higher at 8.2 percent, but Baltimore City public schools are reporting asthma prevalence rates as high as 20 percent. This is significantly higher, and we are trying to figure out why,” says Christina Schwindt, MD, assistant professor of pediatrics and medical director Dominique Richardson is one of 200 students of the Breathmobile. aided by the Breathmobile. “Over the past 15 years, asthma-related deaths for children nationally have more than Michele Foster, RN, evaluate and edudoubled,” says Schwindt. “In 5- to 14cate children and their families. The year-olds with asthma, deaths increased Breathmobile is also a training site for from 55 to 135 from 1979 to 1995 in medical students and the United States.” pediatric residents, as With that in mind, the well as undergraduate Breathmobile staff visits city schools and graduate nurses. four days a week. “Asthma attacks can Blaisdell hopes to be prevented by helping children increase funding so that identify what triggers their asthma. pharmacy and social That way, they can better control work students can join wheezing, chest tightness, and breaththe effort. “The planing difficulty,” says Schwindt. “With ning team that worked proper care, treatment, and education, for two years to bring asthma deaths can also be prevented.” the Breathmobile to this The 34-foot-long, 8-foot-wide area was a multidiscipliBreathmobile is divided into two exam nary team from the

University,” she says. The Breathmobile is a collaboration among the University of Maryland Hospital for Children, the Asthma and Allergy Foundation of America Maryland-Greater Washington, D.C., chapter (which provided initial funding), the Baltimore City Health Department, and the Baltimore City Public School System. The program is

“Children in urban environments are at higher risk for asthma attacks.”

also supported by financial and in-kind donations from ALK-Abello, Apple Ford, AstraZeneca, GlaxoSmithKline, Lincoln Diagnostics, Merck, the Maryland State Board of Education, and the Thomas Wilson Sanatorium. Their support for the Breathmobile, says Blaisdell, will help children like Jasmine miss fewer school days, stay active, and experience fewer trips to the emergency room.

A C C E S

Employee Assistance Programs Meet Workforce Demands By Rosalia Scalia

MARYLAND OF

UNIVERSITY

Dale Masi’s research examines how EAPs are adapting to ever-changing workplace environments.

coworker commits suicide, leaving management and colleagues to cope with the loss. A distraught employee pitches his computer onto the floor, tosses personal effects at coworkers, and threatens to kill them. Terrorists kill thousands of employees and hundreds of rescue workers. In light of these workplace scenarios, how do companies help their employees deal with tragedies and still consider the bottom line? The events of Sept. 11, 2001, changed the role and scope of employee assistance programs (EAP). Though EAPs have played a critical role in employee-employer relations for more

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than 30 years, they have gained even greater importance after Sept. 11. “To protect themselves from liability and to stay competitive, companies now must have crisis incident and disaster plans in place and provide services to employees who are affected by external events that unfold at the workplace,” says Dale Masi, DSW, professor in the School of Social Work and chair of the Employee Assistance Specialization track. Referring to the victims and rescue workers injured or killed in the three cities on Sept. 11, Masi says, “Keep in mind, Sept. 11 affected many people at work. Whether they were in offices or part of the response team, people were at work and were exposed to situations of extreme stress, loss, and crisis,” she adds. “There is nothing new about occupational social workers, but the concept of employee assistance programs is relatively new, beginning in the 1970s with occupational-related alcoholism programs,” says Masi, recently named a Fulbright Senior Specialist. “What is more recent is the notion of specialized training for social work professionals who focus on EAPs in particular.” After Sept. 11, companies with EAPs expanded their programs to include disaster planning, and many companies that did not offer EAPs hastened to implement them. Funded by corporations interested in bottom-line results, Masi conducts research as well as clinical reviews of programs and gives the reviews a rating. She also works in conjunction with the Council on Accreditation to establish national EAP guidelines. Masi has received approximately

PHOTOGRAPH BY ANN GRILLO

$100,000 from Ceridian LifeWorks Services for four collaborative research projects between Ceridian and the School of Social Work. These projects will determine why employees use telephone counseling sessions and online EAP services and will examine the outcomes of those services. Aside from helping employees, Masi says employers also benefit. “There are real bottom-line reasons to offer EAPs,” she says. “My research shows that companies providing employees with comprehensive employee assistance programs enjoy greater bottom-line benefits. EAPs average a $3 return per $1 invested, but can return as much as $13 on the dollar when addressing poor performance.” To remain competitive, companies now offer employee assistance programs that provide a range of services, from substance abuse treatment, family problems, AIDS, and child care, to workplace issues—sexual harassment, discrimination, workplace violence, and communication and personality problems. In addition, service delivery has expanded with increased access to the Internet, allowing employees to access services online. All EAP students at the School of Social Work must take a course titled Management and Administration of Employee Assistance during which they design an EAP for a hypothetical company. Students also learn about current developments in employee assistance such as managed care. Still, says Masi, the biggest issue is not new developments within the profession. The challenge is addressing the shortage of faculty needed to fully staff and further develop existing educational programs or to start new ones. For employers and employees, EAPs represent a win-win situation. According to Masi, “Employees tend to stay on the job and remain loyal to employers whom they perceive to be sympathetic to their problems.”

New Nathan Patz Law Center Emphasizes Access The Ceremonial Courtroom is accessible to people of all physical abilities and challenges.

By Danielle Sweeney and Brian Shea or visitors who face physical challenges, the new Nathan Patz Law Center’s design features will mean the difference between frustration and dignity. Instead of satisfying the minimum requirements of the Americans with Disabilities Act, the School followed the suggestions of architectural experts, disabled individuals, and advocates for the disabled, including the late Stanley S. Herr, JD, DPhil, a longtime faculty member. The School believes the results will be a touchstone for future building projects within the legal and higher education communities. Counter heights in serving areas are 34 inches—not the usual 36—because wheelchair users are more comfortable seated at that height. Wheelchair users also need wider aisles, so aisles in student locker areas are 7 feet, 3 inches—wide enough for two wheelchairs to pass at the same time. From high-tech lecterns, professors can project any object or document on any surface in the classroom, aiding instruction to all students, but especially to those who are visually impaired. Anyone with visual impairments can also access numerous computers that are especially equipped to display super-sized fonts or convert screen text and images into voice-articulated material. Persons with hearing impairments are accommodated by infraredassisted listening systems—computers that translate the spoken word into text. Even the carpet throughout the law building was chosen with users’ special needs in mind. All carpeting is nondirectional, because directional designs can affect individuals who have vertigo. “We didn’t just want to construct a building—we wanted to build a community that recognizes the needs of all its members,” says Karen H. Rothenberg, JD, MPA, dean

and Marjorie Cook Professor of Law. “Architecture sends a message about the values and culture of an institution,” says Alan D. Hornstein, JD, MA, a professor in the School of Law who served on the building committee and who, along with Rothenberg, wrote an article on the law center’s access features for the American Bar Association’s Mental and Physical Disability Law Reporter. “We had to reflect the dignity of each member of the School’s community in the building, despite the additional cost,” Rothenberg says. The Center cost $54 million, including substantial private donations, to build, furnish, and equip. With state and federal courts holding sessions in the facility and the Clinical Law Program providing legal services for clients from across the state, the building will serve more than the law school community. Judges, litigants, witnesses, and jurors will also use the ceremonial courtroom. “We wanted to offer a dignified welcome to everyone who visits the building,” says Rothenberg, “whether they come every day to study law, or just once for a special function.” The Nathan Patz Law Center, located at 500 W. Baltimore Street, at the corner of Baltimore and Paca streets, opened in July 2002. The facility was dedicated last fall at a special ceremony attended by Supreme Court Justice Ruth Bader Ginsburg, who welcomed a student body of 223 students out of a record 4,782 applicants—an 85 percent increase in applications over the previous year. The School of Law has three specialty programs ranked among the top 10 in the nation by U.S. News & World Report *— Environmental Law (fourth), Law & Health Care (fifth), and Clinical Law (10th).

A C C E S S

GCRC Broadens Research Access for Investigators By Nancy Grund

UNIVERSITY

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ver the last four decades, nearly every major medical discovery made in this country has involved research conducted in one of 81 General Clinical Research Centers (GCRC), says Carol O. Tacket, MD, professor of medicine. Last April, the School of Medicine and the University of Maryland Medical Center held a ribbon-cutting ceremony to mark the opening of its own GCRC, which is backed by a fiveyear, $12 million National Institutes of Health (NIH) grant. Located on the 10th floor of the medical center, the GCRC provides centralized resources and expertise to help faculty members conduct safe, efficient, and cost-effective clinical trials and other human research studies in a patient-friendly environment. “The personnel and resources provided by the GCRC will enable us to expand basic science research to develop life-saving drugs, devices, and therapies,” says Donald E. Wilson, MD, MACP, vice president for medical affairs and dean of the School of Medicine. Wilson is the principal investigator for the GCRC grant. Tacket is the GCRC program director. “Before the GCRC, many clinical researchers had to find their own space, whether it was a converted office or a small lab, and use that limited space to conduct their research, often in isolation and with limited resources,” says Tacket. “Now, researchers can work in close collaboration with colleagues, using GCRC space and support from GCRC physicians, nurses, dietitians, biostatisticians, technicians, and administrators.”

The GCRC uses a dual-energy X-ray absorptiometry machine to study bone density and bone diseases.

The outpatient wing of the GCRC includes four examining rooms, five recliners with privacy curtains, five phlebotomy chairs, a nursing station, and multiple computer workstations. The wing also includes a specimenprocessing laboratory and equipment to measure bone density. The unit can accommodate 4,800 research volunteers annually. The inpatient facility has 11 beds and 24-hour nursing care for patients. It can also be used as an isolation ward for Center for Vaccine Development research, such as studies of live oral vaccines for typhoid and cholera. Those studies require that patients stay in the hospital for up to 10 days at a time. For investigators, the GCRC provides access to a central facility for seeing patients who are enrolled in research studies, as well as access to

additional funds for ancillary research costs and administrative and technical support. The center’s Genomics Core prints and reads DNA microarrays and handles gene sequencing and genotyping. The Bioinformatics Core staff assists investigators with all phases of data management, and the Biostatistical Core provides consultation on study design, sample size, and proposed statistical analyses. A biostatistician also helps investigators prepare reports and manuscripts. For each study, the data and safety monitoring staff work with investigators to develop study-specific plans for patient safety and quality management. One of the GCRC’s most promising studies, says Tacket, is led by co-principal investigators Alan C. Farney, MD, PhD, assistant professor of surgery and director of the Islet Cell

Transplant Program, and Kristi Silver, MD, assistant professor of medicine and assistant program director of the GCRC. They are leading research on islet transplantation, a possible treatment for type 1 diabetes that is less complicated and less invasive than a pancreas transplant. If successful, islet transplants could help patients with type 1 diabetes achieve insulin independence, avoiding the need for daily insulin shots or an insulin pump, and also decrease the likelihood of developing diabetes-related complications. “The GCRC makes this study possible,” says Silver, explaining that to staff the islet study without the GCRC, she would have to shuffle current assignments, possibly shortchanging other projects. Instead, the GCRC staff supports the transplant research, and her staff remains intact for other ongoing projects. Also through the GCRC, Charles D. Howell, MD, associate professor of medicine, is leading an eightcenter clinical trial sponsored by $1.3 million from the National Institute of Diabetes and Digestive and Kidney Disorders, NIH. His study may provide clues as to why blacks do not respond as well as

Researchers use data (like this lumbar spine readout) to detect abnormalities.

whites to therapies for hepatitis C. Approximately 400 patients are participating in Howell’s study, which tests the effectiveness of a long-acting interferon, injected weekly by the patient, and ribavirin, an antiviral pill taken daily. “The GCRC provides the space and nursing support to evaluate our patients and collect blood and tissue samples within an outstanding clinical research facility,” says Howell. He notes that without the GCRC, he would have incurred additional costs for facilities and diagnostic tests, and he might be using clinical office space that is not particularly well-suited to research. According to Howell, “a wellfunded GCRC was an important factor in our ability to compete successfully for this prestigious award.” In another GCRC study, Marc C. Hochberg, MD, MPH, professor of medicine and head of the Division of Rheumatology and Clinical Immunology, is following nearly 700 elderly men who live in the Baltimore metropolitan area over four years to evaluate a number of risk factors for osteoporosis and related fractures. The study also compares bone mass in elderly black and white men. Study participants make annual visits to the GCRC to undergo a number of tests, including one that measures bone density using the GCRC’s dual energy Xray absorptiometry machine, one of the few available on campus for research. This $1.4 million study is sponsored by the Department of Veterans Affairs and the Arthritis Foundation. Currently, some 20 studies are under way in the GCRC, and the list continues to grow as Tacket engages researchers from the schools of pharmacy, nursing, and dentistry, as well as the School of Medicine. Says Tacket, “We are eager to increase use of the facility and broaden access to clinical studies for both researchers and their patients.”

HS/HSL Points Consumers to the Best Health Information On the Web http://www.hshsl.umaryland. edu/resources/consumer The University’s Health Sciences and Human Services Library’s (HS/HSL) wealth of medical and scientific resources are not just for academic communities. To help consumers wade through the sea of health information on the World Wide Web, the HS/HSL’s information specialists have created lists of Web sites for consumers seeking health information. These Consumer Health Links include reliable Web sites devoted to nine subject areas: AIDS, cancer, children’s health, diabetes, drug information, maternal and child health, smoking cessation/tobacco, substance abuse, and top Web sites. Web sites are chosen based on the following criteria: ease of identification, frequency of updates, quality of factual and verifiable information, intended audience, and ease of use. The library serves as the Southeastern/Atlantic Regional Medical Library—one of eight regional libraries of the National Network of Libraries of Medicine. One of the network’s missions is improving the public’s access to information to help them make informed health decisions.

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that their safety is a concern to management, so the collaboration between labor and management has been crucial to the success of the program,” says Lipscomb. “We got the workers involved in our research from the very beginning because it is essential that they be part of the solution.”

Five School of Nursing Professors Lead the Way in Research By Danielle Sweeney

Lipscomb says that implementing and sustaining a comprehensive violence prevention program is an ongoing project. “Although we are still evaluating the project’s impact on staff assaults, both management and labor representatives report that the project is having

the direct effect of improving ward security and working conditions,” she says. Lipscomb’s study will conclude in September 2003; however, she has received two additional grants to study violence in home care in Maryland and social services in New York.

Professors from the School of Nursing’s Departments of Behavioral and Community Health and Adult Health Nursing are health research that will improve workplace health and well-being of communities.

hysical violence is pervasive in mental health care facilities. A recent study published in the American Journal of Industrial Medicine found that 73 percent of employees surveyed at a Washington state psychiatric hospital had reported at least one minor injury in the previous year. In 1996, the Occupational Safety and Health Administration (OSHA) published violence prevention guidelines for health and community workers. Although the guidelines are widely respected, they have not been evaluated in the field. Jane Lipscomb, PhD, RN, FAAN, an associate professor in the School of Nursing, is the principal investigator on a three-year, $680,413 grant to study the effectiveness of implementing these violence prevention guidelines in four New York state psychiatric hospitals. “We’re studying the effectiveness of implementing voluntary guidelines,” says Lipscomb. The purpose of the guidelines is to create conditions that prevent patients from becoming violent. Patients become violent for

many reasons. “Some have conditions that interfere with impulse control. Others have risk factors, such as a history of violence or taking the wrong medication or the wrong dose of medication.” The hospital itself may contribute to an unsafe work environment, says Lipscomb. “There could be architectural problems—such as ‘blind spots,’ where patients are out of view, or a treatment room with only one exit— or organizational problems, such as staff shortages and overwork,” she says. The health care workers who sustain the most injuries in psychiatric hospitals are therapeutic aides. Their work is similar to that of nurses’ aides in that they have the most patient contact. They may help patients bathe, dress, groom, and eat and may also lead patients in social and recreational activities. The most common physical injuries these aides experience in mental health facilities are strains, bruises, and lacerations, although more severe ones can and occasionally do occur. Threats of

assault, which may be associated with emotional injury, take place with increasing regularity. “Over the long term, this stress could result in chronic mental health problems and work-related disability,” Lipscomb says. The aim of the study is to document how OSHA violence prevention guidelines can be implemented, and to compare assault rates, risk factors for assault, and the job satisfaction of workers, one year before and one year after the implementation of the guidelines. To do this, Lipscomb’s team set up labor-management advisory groups, conducted focus groups that included the hospital staff, and conducted a pre-intervention survey. As part of the worksite analysis, the team conducted a walk-through environmental evaluation of the facilities. The intervention consists of a comprehensive violence program that focuses on improving security within the work environment and worker training. “Front-line workers often don’t feel

PHOTOGRAPH BY KEVEN WEBER

Jane Lipscomb

PHOTOGRAPH BY JOE RUBINO

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Violence Prevention

hen people learn that they are living near an environmental hazard, their first questions are not about technical issues. “They’re about health issues,” says Barbara Sattler, DrPH, RN. “Will the chemicals hurt my kids? Will they give me cancer? Will our baby have birth defects?” Nurses are especially well-suited to answer these questions, says Sattler, the director of the Environmental Health Education Center and associate professor in the Department of Behavioral and Community Health at the School of Nursing. “Aside from being good listeners, nurses can translate complex information into a language that the public understands. And people in the community trust us.” That’s one reason why Sattler was awarded a $364,000, five-year subcontract to provide community outreach for the Center for Hazardous Substances in Urban Environments. The center, which is headquartered at the Johns Hopkins University Department of Geography and Environmental Engineering, is one of five Environmental Protection Agencysupported Hazardous Substance Research Centers (HSRC) around the country. It is responsible for educational outreach in five states and the District of Columbia. Robyn Gilden, MS, RN, a program manager in the School, manages the subcontract. HSRCs have been in place for several years, but their outreach was mostly technical, Sattler explains.

safety, the quality of health care, and the

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“This is the first time an HSRC has partnered with a school of nursing.” The team members at Hopkins are environmental engineers. They assess the present conditions and develop new mechanisms for remediating these sites, says Sattler. “Hopkins approached us to do the outreach because they know nurses have outstanding communication skills.” One of the center’s outreach objectives is to explain to community members their rights as residents who

live near contaminated sites. Another objective is to respond to community members’ questions. “Sometimes they just want us to explain technical reports. Others have asked if we could help them develop a community health survey,” Sattler says. The center is working with several

for development. Citizens feel like they can talk to the nurses honestly, says Sattler. “We’re not perceived as radical environmentalists. We have a distinct mission: to find out what environmental health risks might exist and educate the community about them.”

Barbara Sattler

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communities in Baltimore, including a citizens group in the Brooklyn/Curtis Bay/Fairfield area of south Baltimore. “We’re helping them interpret environmental impact statements associated with new commercial development in their community,” Sattler says. In east Baltimore, the center is helping a community navigate the probable redevelopment of two contaminated sites. “An adjacent site in current operation is also a concern,” Sattler says. “It’s a man-made pile of rubble with high levels of lead, dust, and heavy metals.” In the Woodberry area, the center is working with a group concerned about an urban forest that is the site of two former landfills and slated

Educating the Public about Environmental Dangers Close to Home

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Denise Korniewicz, DNSc, RN, FAAN, a professor in the School of Nursing, has a four-year, $1 million grant from the CDC’s National Institute of Occupational Safety and Health (NIOSH) to investigate whether safety devices can prevent needlesticks and “sharp” injuries in operating rooms. “Part of what we’re trying to find out is whether the indicator glove works,” says Korniewicz. An indicator glove is a two-layer glove—green on the bottom and white on the top— that shows green when the glove has been cut or punctured by a needle or sharp instrument. Manufacturers claim that the indicator glove alerts workers if their glove

Overwork and Understaffing Affect Health care Workers’ Health

Alison Trinkoff egularly working long hours can have negative consequences on health care workers’ safety and health. This is particularly true for nurses, who are increasingly expected to work overtime because of the nationwide nursing shortage. “There are mandatory overtime requirements at many hospitals these days,” says Alison Trinkoff, ScD, RN, FAAN, a professor in the School of Nursing. Trinkoff is the principal investigator on a $1 million grant from the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (NIOSH) to examine the relationship between work hours and injuries. Specifically, her research will determine whether extended work schedules contribute to an increase in musculoskeletal disorders and needlestick injuries in nurses. Previous NIOSH research by Trinkoff (and School of Nursing Associate Professor Jane Lipscomb, PhD, RN, FAAN) showed that neck, shoulder, and back injuries are associated with working non-dayshifts, weekends, and longer workdays (12 or more hours) during a workweek of at least 40 hours.

Her current four-year study includes a longitudinal survey of the schedules, experiences, and injuries of 3,500 RNs who have a range of specialties and work in various health care settings. Trinkoff believes that working too many hours for days and weeks at a time may manifest itself in additional injuries. “Nurses are spending more time working, so they have more opportunities to be injured,” she says. And, when nurses are injured, they have less recovery time, because they have to return to work right away, Trinkoff says. “It’s a little like a pitcher who hurts his arm one day and is back playing ball the next—the recovery is more difficult.” Trinkoff is also the principal investigator on a two-year, $694,052 grant from the Department of Health and Human Service’s Agency for

Healthcare Research and Quality to examine whether nurse staffing and skill levels are associated with increased worker injuries and adverse patient outcomes. In a 2000 American Nurses Association survey of 7,299 nurses, 5,067 (almost 70%) believed that inadequate staffing—either not enough staff or staff with limited skills—was a chief cause of diminished patient care. Examples of diminished care could include higher r a t e s o f c o m p l i c a t i o n — s u c h a s postsurgical infections—and higher mortality rates, says Trinkoff. “In nursing, there’s a culture of not thinking about your own health. A certain level of sacrifice is expected. Theoretically, many nurses have 40hour work schedules, but because of the 24/7 nature of the job and nurses’ accountability, it’s hard to set limits on their schedules,” Trinkoff explains.

Carles Muntaner

Preventing Needlestick and Sharp Instrument Injuries

ualities of the workplace, or “organizational factors,” play a role in the prevalence of physical and mental illnesses among employees. Carles Muntaner, MD, PhD, a professor in the School of Nursing, is the primary investigator (with Jane Lipscomb, PhD, RN, FAAN, and Alison Trinkoff, ScD, RN, FAAN) on a $742,500 grant from the Centers for Disease Control and Prevention’s

Denise Korniewicz he Occupational Safety and Health Administration estimates that as many as 5.6 million health care workers are at risk of being exposed to blood-borne pathogens, such as HIV and the hepatitis B and C viruses. About 385,000 times a year, health care workers in hospitals are injured by needles and cut with sharp instruments—which can expose them to these pathogens—according to the Centers for Disease Control and Prevention (CDC).

needs to be replaced and that workers replace gloves faster as a result, but there is little or no research data proving the effectiveness of indicator gloves. During 2001, Korniewicz’s first year of research, she developed an operating room data form to collect data on sharp and needlestick injuries. The University of Maryland Medical Center is using the form in 23 operating rooms and at Shock Trauma. More than 285 attending physicians, residents, fellows, scrub techs, and scrub nurses are enrolled in the study. The circulating room nurse in each operating room fills out the form every time a surgical team member changes gloves, noting the reason for change, the location of the puncture or tear, and whether the

Workplace Factors Affect Workers’ Physical and Mental Health

PHOTOGRAPHS BY JOE RUBINO

National Institute of Occupational Safety and Health (CDC/NIOSH) to study the link between organizational factors and the incidence of depression and musculoskeletal disorders (MSD) among home health care workers. MSDs are injuries to the nerves, tendons, muscles, and supporting structures of the body. They are typically caused by heavy lifting, pushing, pulling, or carrying heavy objects,

worker saw blood on the gloves. One form is used for each surgical procedure. A 32-month data collection period began in May 2002. “During phase one of the study, we will determine whether the indicator glove system versus regular surgical gloves really works,” says Korniewicz. “During phase two, we’ll determine whether other safety devices—such as blunt needles and retractable scalpels— reduce the rate of injuries.” After the data are collected, Korniewicz will compare the needlestick and sharp injury rates with prestudy rate data. Her results will help NIOSH make recommendations to hospitals and surgical centers nationwide.

and prolonged awkward postures— activities widely performed by home health care workers. Working conditions for home health care workers are variable—most are employed by agencies and visit several homes a day—and largely unregulated. Their median hourly earnings were $7.91 in 2000 according to the Department of Labor’s Bureau of Labor Statistics, which estimates that home health care workers held 615,000 jobs in 2000. What factors of home care work affect mental health and bring about MSDs? “There seem to be many,” Muntaner says. “Is it driving many miles a day from one assignment to another or working alone? Is it being more vulnerable to assault in a private home or working in a dangerous neighborhood?” “Much previous research focused on the character and culture of workers. My research is about the culture of the work environment: the economic, political, and social factors that define an organization and affect the health of its workforce,” says Muntaner. His study of 1,000–2,000 home health care workers in Los Angeles County, Calif., will conclude in 2004. Muntaner is also the primary

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Muntaner has found that because of the physical and emotional demands of the job, poor working conditions, low pay, and lack of benefits, nurse assistants may have a higher rate of symptoms of depression compared to that of the general workforce. In West Virginia and Ohio, for example, his research shows that nurse assistants are three times more likely to suffer from depression than workers in other fields. Muntaner’s findings will be distributed to nursing home administrators and organizations that advocate

for the elderly, like the AARP. Muntaner believes that when a critical mass of studies have been completed, there will be empirical evidence to demonstrate a need to improve nursing home workplaces. “The point of doing the research is to protect the workers—to change the organization or environment—and as a consequence, improve the quality of care patients receive,” he says. “This will affect us all, eventually, as we and our families grow older and enter nursing homes.”

Pharmacist Shortage Threatens Access By Randolph Fillmore

ith pharmacists in short supply, and the need for prescription drugs escalating sharply, could access to prescription drugs and patient care by pharmacists be hampered? Perhaps. “Today, we are short about 7,000 pharmacists nationwide. By the year 2020, we could have a shortfall of more than 100,000 pharmacists,” reports David A. Knapp, PhD, dean of the School of Pharmacy and convener of a national conference on Professionally Determined Need for Pharmacy Services. The conference, sponsored by the Pharmacy Manpower Project Inc. (PMP), included projections based on demographic realities. PMP collects, analyzes, and disseminates data on the supply of licensed pharmacists in the United States, the demand for pharmacy services, and related pharmacy student and workforce issues for educational, scientific, or charitable purposes. Knapp, who received a grant from PMP to put on the conference, says one factor influencing the shortage is the aging baby boomer population causing a sharp increase in prescription drug use and the need for pharmacist patient care services. The shortage is on the federal government’s radar. In December 2000, the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration, published a report, The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists, which predicts that 4 billion

prescriptions will be ordered in 2004. The report cautioned that a pharmacist shortage could increase the risk of inappropriate medication use and thus reduce quality of care. Technology such as electronic prescribing and robotic order filling can help. Although the Veterans Administration already has a shortage of pharmacists, HHS praised the efficiency and safety record of the VA’s computerized pharmacy. Lou Cobuzzi, MS, chief of pharmacy services at the Baltimore VA Medical Center, says that the pharmacist shortage at VAs has become acute in some regions. Current technology, such as bar coding and computerized dosing, has helped, but it’s not the answer, says Cobuzzi. “Technology allows us to do more,” he says, “but it doesn’t really help with the vacancy problem.” Federal health systems are recruiting, but have stiff competition from chain pharmacies, which are also feeling the pinch. “We can help meet the future challenges by improving drug therapy management, improving electronic communication, and by using automation, robotics, and support personnel,” says Knapp. Training more pharmacists means that the educational system must respond to tomorrow’s needs today, he says. “The School of Pharmacy has restructured and modernized its curriculum. We strengthened our faculty when we began

our four-year PharmD program in the mid 1990s,” says Knapp. Enrollment in the PharmD program increased by one-third in the mid 1990s and by another 30 percent in 2001. Knapp says one solution would be to accelerate construction of the Pharmacy Hall Addition for occupation before the 2010 projected opening date. As the only pharmacy school in the state, the University’s School of Pharmacy trains the majority of pharmacists in the region. The School, ranked seventh in the nation by U. S. News & World Report, also draws students from 33 states. “The increasing demand for pharmacists in Maryland is greater than the number of students we can accommodate,” says Robert S. Beardsley, PhD, associate dean of student affairs at the School. “Our current space is insufficient to sustain our programs. In 2002 we turned away three students for every applicant we enrolled.” To accommodate more students, the School refitted two main classrooms in Pharmacy Hall, removing one of the aisles to add more seats. Federal legislation may offer some help. The Pharmacy Education Aid Act of 2001, introduced both in the U.S. Senate (SB 1806) and the U.S. House of Representatives (HB 2173), if passed, will provide for construction, renovation, and funds to expand enrollment at the nation’s pharmacy schools. Funds will also be provided to recruit and retain faculty and offer financial aid to pharmacy students. Senator Jack Reed (D-RI), who introduced the act in December 2001, says that it “takes a multifaceted approach to the problem of workforce shortages in pharmacy.” Everything helps, says Knapp.

Thomas Perez is using civil rights laws to address barriers to health care.

Discrimination Hinders Health Care Access By Regina Lavette Davis

t is really deadly to be poor in America,” says University of Maryland School of Law Professor Thomas E. Perez, JD, director of the Clinical Law Program. Solving the problems of access to health care, he says, is both a civil rights and a public health challenge. “Poor people are more likely to have difficulty accessing quality health care,” he says, adding that,“Economics is not the end of the analysis; it can also be deadly to be a person of color.” Perez was a contributing author to the Institute of Medicine’s (IOM)

“I

PHOTOGRAPH BY ANN GRILLO

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investigator on a $385,000 grant from the CDC/NIOSH to study work organizational factors and depression among nursing home aides. “Factors associated with depression in nursing home aides include: a bureaucratic management style, labor relation violations, unfair discrimination practices, and in general, a bottomline orientation,” says Muntaner. “This environment won’t just affect some workers, it will affect most. It will affect the average worker, and I can measure this effect with my analysis.”

landmark 2002 report on health care disparities, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The study, sponsored by federal agencies, concluded that minorities in America receive a lower quality of health care than non-minorities. Donald E. Wilson MD, MACP, vice president for medical affairs and dean of the School of Medicine, says “There is no question that disparities in medical care exist, and we need to address that.” Although Perez cites economics and

geography as contributing factors in health care disparities, his chapter in the IOM’s report focused on discrimination and reported on how existing civil rights laws can be used to resolve health care disparities. The Department of Health and Human Services (DHHS) defines health disparities as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.” DHHS selected six areas in which

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racial and ethnic minorities experience serious disparities in health access and outcomes: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV/AIDS, and immunizations. Effectively addressing the issue of disparities, says Perez, must begin by exploring why some diseases are more prevalent among particular ethnic groups and why minorities receive certain treatments in fewer numbers than whites. For example, in his IOM chapter Perez cites a 1999 report stating that controlling for all factors other than race and gender (e.g., economics, health status, etc.), whites were four times more likely to be referred for cardiac catheterizations than blacks. These procedures, he says, are critical diagnostic tools used to detect whether someone needs a surgical procedure such as a bypass or angioplasty. The IOM study found that even when insurance status and income are controlled, racial and ethnic disparities still exist. Discrimination, then, becomes a significant factor that shapes the issue—an area that much of society has been averse to recognize, says Perez. “Society does not want to believe that health care professionals discriminate.” Putting on a white coat does not erase bias, he adds, because “health care professionals are human, just like anyone else.” What society needs to understand, he says, is that “discrimination is found everywhere—from the courtroom to the boardroom to the emergency room.” Most of the bias, he says, is subtle and unintentional, and providers often make “stereotypical judgments that can adversely affect how health care is delivered.” He traces this subtle bias to an “outgrowth of de facto segregation.” Health care providers have too little contact with people of other races, creating an absence of understanding, he explains.

This discrimination is not necessarily limited to individuals, but may be found in large organizations. Perez explains: “An entity may have a policy or practice in place that has no discriminatory intent, but has that effect.” His research cites examples where hospitals or managed care organizations have required patients to bring their own

“Society does not want to believe that health care professionals discriminate.”

interpreters. “That has the effect of discrimination under federal law,” says Perez. [The University of Maryland Medical Center provides translation for patients through the Berlitz Professional Interpreter Exchange Program.]

SOLUTIONS Part of the solution, says Perez, is to use civil rights remedies to address practices that may be in violation of the law. Title VI of the Civil Rights Act of 1964, he says, is a primary tool used to find legal redress for cases of health care discrimination. This provision, he says, prohibits discrimination based on race, color, or national origin, in any program or activity that receives federal financial assistance. Most health care providers get some form of federal help, says Perez. “Health care providers,” he adds, “need to take a comprehensive look at how they deliver services and review

policies that seem neutral, but may adversely affect some communities.” Something as simple as reviewing the ZIP codes where health insurance is marketed is a positive step, says Perez. This measure would ensure that individuals in minority communities have access to information and opportunities to participate in health plans. In terms of health care practitioners, he says that problems of discrimination can be addressed by “training a cadre of culturally competent health care providers.” “What we need,” agrees Wilson, “is a population of doctors who can provide excellent care to an increasingly diverse population.” Solutions from the Institute of Medicine include a call for a comprehensive, multilevel strategy that increases the awareness of “health care gaps” across health care systems and society. The organization also favors economic incentives for health practices that seek to improve patientprovider relationships. Perez is currently involved in projects that seek creative solutions to access disparities in health care. One project is with the Association of American Medical Colleges to enhance diversity programs, targeted at how to revise the definition of underrepresented minorities. Another goal is to broaden strategies for how health professionals can attract diverse populations. Also, Perez is working with The California Endowment, providing technical assistance for a program aimed at ensuring access to health care for people in immigrant communities who are English-deficient. At the School of Law, Perez covers this issue in the classroom as well. “We will address it in the civil rights clinic as we explore the intersection of health care and civil rights.” “We need to respond accordingly as a society to ensure that diverse communities have access to health care and insurance,” he says.

DONOR

PROFILE

Nathan Patz’s Family and Friends Donate $5 Million New Law School Building Named in His Honor By Danielle Sweeney

Nathan Patz Law Center

PHOTOGRAPH OF MRS. PATZ AND RUTH BADER GINSBURG BY BILL MCALLEN

Doris Patz and Justice Ruth Bader Ginsburg at the dedication of the Nathan Patz Law Center.

“A MASTER BUILDER IN LAW AND IN LIFE, NATHAN PATZ WAS THE VERY MODEL OF THE ETHICAL, VIGOROUS, AND WISE COUNSELOR,” SAID SUPREME COURT JUSTICE RUTH

Bader Ginsburg during her opening remarks at the dedication of the Nathan Patz Law Center this past fall. Nathan Patz’s family and friends gave the School a $5 million endowment. In recognition of the gift, the school’s new building was named the Nathan Patz Law Center. Doris Patz knows how her late husband, Nathan, would feel about his name gracing the School of Law’s new building. “He would be tremendously proud,” she said at the dedication. “Nate was so grateful for all that the School gave him.” “This money is about people and programs, not bricks and mortar, says School of Law Dean Karen H. Rothenberg, JD, MPA. “We have the physical structure, now we can transform what goes on inside. This gift will

allow us to make enormous strides in faculty development, and it will help seed new initiatives, enhance existing programs, and enrich student life.” Nathan Patz, who died in 1998, was a 1926 graduate who practiced law in Baltimore for more than 70 years. He served as president of the Bar Association of Baltimore City and was appointed by three governors to the Maryland Judicial Disabilities Commission–– the body that reviews complaints against judges in Maryland. Doris Patz said that her husband tried to live the life of a model lawyer. “He tried to help The late Nathan Patz those who needed a lawyer, but could not afford one, and he didn’t seek attention for his efforts,” she said. The School’s nationally ranked Clinical Law Program follows this example, with students working directly with low- and moderateincome clients in the community. Patz believed in the work of the Law School. He served terms as both the president of the University of Maryland School of Law Alumni Association and the University of Maryland Alumni Association International, and in 1980, he and his wife established the Nathan Patz Student Loan Fund to aid those seeking a legal education at the University. Shortly after, he established the Nathan Patz Law Library Fund to support the Thurgood Marshall Law Library. “Nathan Patz was a man of professionalism, integrity, and service,” says Rothenberg. “It’s wonderful to memorialize someone who symbolizes what we teach here.” Says University President David J. Ramsay, DM, DPhil, “Nathan Patz practiced law here in Baltimore until he was in his nineties, and his professional, business, and civic accomplishments are held in high esteem. His gift is both a wonderful opportunity, and a tremendous honor, for the School of Law.”

$256 million in FY01 sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million volunteer hours throughout the state • Top-tier law school specialty programs • The School of Medicine has a $100 million endowment • The School of Pharmacy is ranked 7th in the nation • Every state dollar becomes $10 in economic growth • The School of Nursing is the largest in the state • The Dental School is 7th in total NIH funding • 425,000 digital transactions annually at the Health Sciences and Human Services Library • School of Social Work rate of publication is 5th in the nation • First online RN to BSN program in Maryland • The School of Medicine ranks 9th in research funding among public medical schools • The National Museum of Dentistry is the only one of its kind • UMB is Maryland’s only public academic health, human services, and law center • $256 million in FY01 sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • $256 million in sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million volunteer hours throughout the state • Toptier law school specialty programs The School of Medicine $100 million endowment • Thetogether School of Pharmacy is ranked 7th in the nation • Every state dollar becomes $10 ach fall for the past•seven years, the Universityhas of aMaryland community has come in economic growth • The School of Nursing is the largest in the state • The Dental School is 7th in total NIH funding • 425,000 digital transactions annually at the Health Sciences to celebrate The Work themerate for of thepublication 2002 celebration, and Human Services LibraryFounders • SchoolWeek. of Social is 5th in“No theLimits,” nation •gave Firstour online RN to BSN program in Maryland • The School of Medicine ranks 9th in TEACHER OF THE YEAR E R V A N T health, O F T Hhuman E YEA R U B Lpublic I C S academic research fundingfaculty among public medical schools • The National Museum of Dentistry is the only one of its kind • UMB is Maryland’sPonly services, members, staff, and students an opportunity to reflect on the University’s boundless and law center • $256 million in FY01 sponsored research • 390+ companies involved in sponsored research • 100,000+ annualC patient toMtheADental GARY HOLLENBECK, PHD ILLIA . G R IClinic F F I N• 200-year P L . Wvisits • Hosted by President David J. Ramsay his wife, Anne,hours the week’s festivities historyachievements. as an economic development catalyst • More than 2and million volunteer throughout the state • UMB graduates all Maryland-trained dentists research • 100,000+ annualincluded patient avisits the Dental Clinic •cookout, 200-yearahistory an economic development catalyst •byMore than 2 million volunteer hours throughout the state • UMB graduates all stafftoluncheon, a student researchaslecture, and a black-tie gala attended LAST ULY, WHEN CPL. WILLIAM A. GRIFFIN GOT A PHONE GARY HOLLENBECK PHD, KNOWS THAT BEFORE YOU CAN Maryland-trained dentists • Top-tier law school specialty programs • School of Medicine hasrecognized a $100 million endowment • School of JPharmacy ranked 7th in the nation • Every dollar becomes 10 ,dollars in economic growth • School of 700 of the University’s faculty, staff, and friends. • During the gala, President Ramsay message from President David J. Ramsay, DM, DPhil, he introduce students to new ideas and knowledge, you Nursing is the largest in the state • The Dental School is 5th in NIH funding • 425,000 digital transactions annually at HS/HSL • School of Social Work publication rate No. 1 in the region • First online RN to BSN program in have MD to • School started the Founders Week winners, who were public selectedmedical by theirschools peers for•their outstanding contributions respect human the knowledge that they have. • $256 million in of Medicine ranks 9th in award research funding among The National Museum of Dentistry is the only one of its kindto•worry. UMB is Maryland’s only public academic health, services, andalready law center Griffin, a safety officer with research the University “I approachinvolved every classin with the understanding that a•great sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • $256 million inawareness FY01 sponsored • 390+ companies sponsored research 100,000+ in research, public service, and teaching. police department, was on vacation at the time. “I was deal of learning has already taken place,” says Hollenbeck, a a $100 annual patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million volunteer hours throughout the state • Top-tier law school specialty programs • The School of Medicine has for a self-defense instructors conference my • The professor in the Department of in Pharmaceutical Sciences and million endowment • The School of Pharmacy is ranked 7th in the nation • Every state dollar becomes $10 in economic growth •preparing The School of Nursing is the largest in when the state Dental School is 7th total NIH funding • 425,000 colleague Cpl. Shirleen Berry called and said, ‘The president associate dean for academic affairs in the School of Pharmacy. digital transactions annually at the Health Sciences and Human Services Library • School of Social Work rate of publication is 5th in the nation • First online RN to BSN program in Maryland • The School of Medicine ranks 9th in research P H OTO G R A P H S B Y K AT H E R I N E L A M B E RT wants to talk to you right away.’” “That helps to set a tone of mutual respect.” funding among public medical schools • The National Museum of Dentistry is the only one of its kind • UMB is Maryland’s only public academic health, human services, and law center • $256 million in FY01 sponsored research • 390+ Griffin reason Clinic to be concerned. president companies involved in sponsored research • 100,000+ annual patient visits to had theno Dental • $256 The million in sponsoredHollenbeck researchsees • 390+ involved in sponsored himself companies not only as a teacher, but also as a research 100,000+ annual visits to history development than million hours throughout wantedastoan giveeconomic him the good news—Griffincatalyst had been • More processes in• vascular smooth muscle,patient cardiac muscle, andthe Dental Clinic • 200-yearonly student who2works hardvolunteer to master new material and skills. the state • brain Top-tier lawand school programs • The School of Medicine has a $100 endowment • The School Pharmacy is 7thit’s inlike thetonation • Every state dollar namedmillion the Founders Week Public Servant of theof Year. neurons, to thespecialty processes that underlie hypertenHeranked knows what be on the other side of the desk. becomes $10 growth • The School of Nursing is the largest in the state • The Dental School in total NIH funding •“Gary 425,000 digital transactions at He the Health Griffin won the award becauseisof7th his work in crime sion in andeconomic brain cell degeneration. maintains an exceptional level ofannually enthusiasm. Sciences and Human Services Library • School 5th in the nation First online RN to BSN program in with Maryland • The School his of presentaMedicine ranks prevention, is particularly for the success•of the University’s Blaustein earned his bachelor’s degree in zoology from of Social Work rate of publication engages students questions, and modifies 9th in research among public medical schools • The National Museum of Dentistry the only oneheofco-implemented its kind • UMB is Maryland’s only public academic health, human servRape Aggression Defenseisprogram, which Cornell Universityfunding in 1957 and his MD from Washington tions to match their level of understanding,” says Richard ices, and law center • $256 million in FY01 sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic in 1992 and teaches with Berry. The program teaches people University School of Medicine in 1962. Following three years Dalby, PhD, vice chair for academic affairs in the Depart-• 200-year history as an economic development catalyst hours throughout theassaults state •through UMB risk graduates Maryland-trained researchis•widely 100,000+ annuto prevent abductions and sexual avoid- allment in the U.S. Navy and a two-year research fellowship at • More than 2 million volunteer of Pharmaceutical dentists Sciences. Hollenbeck alCambridge patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million volunteer hours throughout the state • UMB ance, risk reduction, and basic hands-on defense. University, he joined the faculty of Washington regarded as an intuitive educator whose opinions aregraduates all Maryland-trained dentists • Top-tier law school specialty programs • School of Medicine has a $100 million endowment • School ofby Pharmacy ranked 7thnot inhaving the nation “Graduates of our course have been attacked and University School of Medicine, where he stayed for 11 years. respected his colleagues. “Despite formal • Every dollar becomes 10 dollars in economic growth • School of Nursing is the largest in the state • The Dental School is 5th in NIH funding • 425,000 digital transactions annually survived because of the skills we taught them,” Griffin says. Blaustein came to the University in 1979 to chair the training in education, Gary is the go-to education guru inat HS/HSL • Department School of Social Work publication rate No. 1 in the region • First online RN to Chief BSN program in MD • School of Medicine ranksthe9th in research funding among public medical schools Police James P. Nestor recalls that a student was of Physiology. In 1985, he became director of School of Pharmacy,” says Dalby. “His views on curricular • the TheUniversity’s NationalCenter Museum of Dentistry is the only one of its kind • UMB is Maryland’s only public academic health, human services, and law center • $256 million in sponsored abducted during a carjacking and remembered from class for Heart, Hypertension and redesign and student assessment are sought by faculty and research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • $256 million in FY01 sponsored research • 390+ companies how important it is to draw attention to a crime being Kidney Disease. administrators not only at UMB, but at other universities, involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million volunteer hours committed. “So she crashed her car into a storefront winBlaustein is listed as the author of one of the 10 most by the American Association of Colleges of Pharmacy.” throughout the state • Top-tier law school specialty programs • The School of Medicine has a $100 million endowment • Theand School of Pharmacy is ranked 7th in the nation • Every RESEARCH LECTURER OF THE YEAR dow, and that caused the abductor to leave the scene,” often cited research articles in the Centennial Celebration From 1991 to 1996, Hollenbeck was a key member of state dollar becomes $10 in economic growth • The School of Nursing is the largest in the state • The Dental School is 7th in total NIH funding • 425,000 digital transactions annufor at thethe American Journal of Physiology. He is alsoServices the committee for designing and implementing M O R D E C A I P. B L A U S T E I N , M D ally Health Sciences and Human Library • School of SocialNestor Worksays. rate of publication is 5th in the nation • Firstthe online RN toresponsible BSN program in Maryland • The School of Griffin became a University security officer in 1984 and recipient of the prestigious Alexander von Humboldt Senior the School’s unique entry-level doctoral program. This new Medicine ranks 9th in research funding among public medical schools • The National Museum of Dentistry is the only one of its kind • UMB is Maryland’s only public academic joined the campus police force a few years later. He attribU.S. Scientist Award. curriculum presented an integration of science and practice, health, human services, and law center • $256 million in FY01 sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental P. BLAUSTEIN , MD, PROFESSOR AND CHAIR OF muchDental of his success crime prevention officer to his Many of Blaustein’s former students have gone•on to featuring active learningcatalyst and performance Clinic M • ORDECAI $256 million in sponsored research • 390+ companies involved in sponsored research 100,000+ annual patient visitsutes to the Clinicas•a200-year history as an economic development • Moreassessment. than 2 million volunthe Department of Physiology in the School of Medicine, is co-workers and his chief. “I worked for Chief Nestor when become leaders in the international scientific community. “We recognized that the knowledge, attitudes growth teer hours throughout the state • Top-tier law school specialty programs • The School of Medicine has a $100 million endowment • The School of Pharmacy is ranked 7th in the nation • Every state dollar becomes skills, $10 and in economic renowned for his groundbreaking research on transport he was a at colonel, and he isSciences the best supervisor and mentor They School rememberishim andfunding supportive required for the provision of pharmaceutical were the • The School of Nursing is the largest in the state • The Dental 7thasina superior total NIH • mentor 425,000 digital transactions annually the Health and Human Services Library • School of Social Work ratecare of publication is 5th across cell membranes and the regulation of intracellular I’ve ever had,” Griffin says. who created an intellectual environment that was demandprimary motivators for educational reform at the School,” in the nation • First online RN to BSN program in Maryland • The School of Medicine ranks 9th in research funding among public medical schools • The National Museum of Dentistry is the only one of its kind • UMB is Maryland’s only and calcium in ahuman great variety of cells.and His internaShirleen Berry, who is •also a public safety officerpatient Hollenbeck exciting, and nurturing. They also remember him •as390+ a says.Dental “And theClinic faculty•wanted its graduates to have publicsodium academic health, services, law center •ing, $256 million in FY01 sponsored research companies involved in Cpl. sponsored research 100,000+ annual visits to the 200-year history as an ecorecognizedcatalyst work has improved of the and works research with Griffin •at100,000+ the Community Outreach Policevisitsevery leaderhours whose throughout example they try to state follow with theirgraduates own career opportunity available to them.” nomictionally development • More understanding than 2 million volunteer the • UMB all Maryland-trained dentists annual patient to the Dental Clinicin•pharmacy 200-year history as an economic inter-relationship between sodium and2 calcium the role hours on Penn and Pratt Streets, won the Founders • Week junior colleagues. the state • UMB graduates all Maryland-trained dentistsStation Hollenbeck has has been teaching at the endowment University for • School of development catalyst • More than millionand volunteer throughout • Top-tier law school specialty programs School of Medicine a $100 million of calcium in controlling physiological processes within cells. Award for Public Service in 1999 and the Board of Regents leadership has manifested itself in many accomplishPharmacy ranked 7th in the nation • Every dollar becomes 10This dollars in economic growth • School of Nursing is the largest in the state • The Dental School is 5th in NIH funding • 425,000 transactions annually at HS/HSL 25 years.digital In that time, says Dean David A. Knapp, PhD, • School His Work studies publication on sodium/calcium of Social rate exchange No. 1 inand thecalcium region • First online RN to BSN program in MD • School Medicine ranks 9th in research funding among public medical schools The National Museum Dentistry only one of its kind Staff Award for Public Service in 2001, both for her work• in ments. Current and former colleagues credit Blausteinofwith he has transformed theofvery definitionisofthe classroom. • UMBsignaling is Maryland’s publicimplications academicforhealth, services, and law center • $256 million in sponsored research • 390+victim-assistance companies involved in sponsored research • 100,000+ annual the Dental have directonly therapeutic treating humantransforming and crime prevention. Maryland’s once very good physiology “For Gary, thatpatient could be visits a collegetoclassroom or anClinic • $256 millionheart in FY01 research • 390+ companies in sponsored research • 100,000+ annual patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million hours diseasesponsored and hypertension. Blaustein’s research has had involved “We’re on the right track,” says Griffin. “We love what department into one that is now considered among the Internet hookup across the country. It is any placevolunteer where throughout the stateto•a Top-tier law school specialty programs • The School of Medicine has a $100 million endowment • The School of Pharmacy is ranked 7th in the nation • Every dollar becomes direct application better understanding of physiological we’re doing. We’re making a difference.” finest in the country. he state can help somebody learn.” $10 in economic growth • The School of Nursing is the largest in the state • The Dental School is 7th in total NIH funding • 425,000 digital transactions annually at the Health Sciences and Human Services Library • School of Social Work rate of publication is 5th in

Founders Week Winners

UNIVERSITY

MARYLAND

/ 2003

UNIVERSITY

LEADERSHIP

MARYLAND OF

UNIVERSITY

DAVID J. RAMSAY, DM, DPHIL President

BARRY HANDWERGER, MD President, Faculty Senate

T. SUE GLADHILL, MSW Vice President, External Affairs

WILLIAM P. CROCKETT JR. Chair, Staff Senate

JAMES T. HILL, MPA Vice President, Administration and Finance

JULIA BERWANGER President, University Student Government Association

JAMES L. HUGHES, MBA Vice President, Research and Development PETER J. MURRAY, PHD Vice President, Information Technology and Chief Information Officer MALINDA ORLIN, PHD Vice President, Academic Affairs DONALD E. WILSON, MD, MACP Vice President, Medical Affairs

ACADEMIC DEANS JANET D. ALLAN, PHD, RN CS, FAAN School of Nursing JESSE J. HARRIS, PHD School of Social Work DAVID A. KNAPP, PHD School of Pharmacy MALINDA ORLIN, PHD Graduate School KAREN H. ROTHENBERG, JD, MPA School of Law CHRISTIAN S. STOHLER, DMD, DRMEDDENT Dental School DONALD E. WILSON, MD, MACP School of Medicine

UNIVERSITY OF MARYLAND B A LT I M O R E F O U N DAT I O N , I N C . BOARD OF TRUSTEES

RICHARD J. HIMELFARB Chair Charles L. Abbott Edward J. Brody Don-N. Brotman, DDS Francis B. Burch Jr. Myrna Cardin James D’Orta, MD James E. Earl Russell B. Fair, RPh Carolyn McGuire-Frenkil Sylvan Frieman, MD Joseph R. Hardiman David Hillman Wallace J. Hoff Sally Michel Milton H. Miller Sr. John A. Moag Jr., Esq Joseph A. Oddis Thomas P. O’Neill Donald E. Roland Pauline Schneider, JD Alan Silverstone, MBA C. William Struever John C. Weiss III Garland O. Williamson Ex-officio Members David J. Ramsay, DM, DPhil Judith S. Blackburn, PhD, MBA T. Sue Gladhill, MSW

BOARDS OF VISITORS DENTAL SCHOOL

STANLEY E. BLOCK, DDS Chair Guy Alexander, DDS Don-N. Brotman, DDS Ann E. Christopher, DDS Alan M. Dworkin, DDS Edward K. Gerner Jr., JD Steven R. Jefferies, DDS Ann B. Kirk, DDS Melvin F. Kushner, DDS Mary M. Littleton, RHD William W. Mumby, DDS Roy C. Page, DDS, PhD, DSC William H. Schneider, DDS David H. Wands, DDS Paul Warren, LDS Ben A. Williamowsky, DDS SCHOOL OF MEDICINE

DAVID S. PENN Chair Charles F. Black Morton D. Bogdonoff, MD Jocelyn Cheryl Bramble Roger J. Bulger, MD Michael E. Cryor William H. Davidow Jr. Sylvan Frieman, MD Ronald Geesey Susan R. Guarnieri, MD Richard M. Lombardo Edward Magruder Passano Jr. Christine D. Sarbanes Carl W. Stearn Richard L. Taylor, MD Daniel E. Wagner

Ex-officio Members Morton D. Kramer, MD Morton M. Krieger, MD

SCHOOL OF LAW

PAUL D. BEKMAN Chair Richard Alter Alison L. Asti The Honorable Lynne A. Battaglia The Honorable Robert M. Bell Richard D. Bennett Laura Black Stephen A. Burch The Honorable Benjamin L. Cardin Harriet E. Cooperman David S. Cordish The Honorable Andre M. Davis Christine A. Edwards Miriam L. Fisher Louise Michaux Gonzales James J. Hanks Jr. The Honorable Ellen M. Heller Henry H. Hopkins Edward F. Houff The Honorable Barbara Kerr Howe Robert J. Kim Trent M. Kittleman Raymond G. LaPlaca Thomas B. Lewis Ava E. Lias-Booker Bruce S. Mendelsohn Col. David B. Mitchell Hamish S. Osborne George F. Pappas Charles E. Peck Joanne E. Pollak The Honorable George L. Russell Stuart M. Salsbury Mary Katherine Scheeler Edward Manno Shumsky Hanan Y. Sibel The Honorable Stuart O. Simms Mark C. Treanor Arnold M. Weiner

SCHOOL OF NURSING

SCHOOL OF PHARMACY

SCHOOL OF SOCIAL WORK

ALAN SILVERSTONE, MBA Chair

RICHARD P. PENNA, PHARMD Chair

EDWARD J. BRODY Chair

William N. Apollony, MBA Douglas L. Becker Gerald T. Brady Lynne Brick Jane Durney Crowley, MHA John C. Erickson, MEd Carolyn McGuire-Frenkil Arthur Gilbert, MBA Sonya Gershowitz Goodman, MS Donna Hill Howes, MS Gail S. Kaplan, MS Rose LaPlaca Anthony R. Masso Esther McCready Marian Osterweis, PhD Morton I. Rapoport, MD Judy Akila Reitz, ScD Barbara M. Resnick, PhD Kenneth A. Samet, MHSA David D. Wolf, MBA

Robert Adams, GS, MGA John H. Balch Alan Cheung, PharmD, MPH Paul T. Cuzmanes, JD Leonard J. DeMino Russell B. Fair, RPh John M. Gregory William M. Heller, PhD Robert Henderson, PD Donald M. Kirson Calvin Knowlton, PhD Henri Manasse, PhD James A. Miller, PD Martin B. Mintz, PD Robert G. Pinco, JD Gordon Sato, PhD David R. Savello, PhD Stephen C. Schimpff, MD Matthew Shimoda, PharmD Alex Taylor David R. Teckman George C. Voxakis, PharmD Clayton L. Warrington Ellen H. Yankellow, PharmD

Mark Battle, MSSA Carolyn Billingsley, MSW Barbara J. Bonnell Barbara Cahn, PhD The Honorable James W. Campbell, MSW Bonnie S. Copeland, PhD Pamela F. Corckran, MSW Erica Fry Cryor, JD Greg DesRoches Betty Golombek, MSW Margot W. Heller Barbara L. Himmelrich, MSW Lenwood Ivey, PhD Jean Tucker Mann, MSW Sally Michel James R. O’Hair, MPSW Vincent Perry, PhD Mary G. Piper, MSW Alison Richman, MSW Stanley E. Weinstein, PhD Susan A. Wolman, MSW

UNIVERSITY SYSTEM OF MARYLAND WILLIAM E. KIRWAN, PHD Chancellor BOARD OF REGENTS

The University System of Maryland is governed by a 17-member Board of Regents appointed by the governor. Lance W. Billingsley, Esq Nathan A. Chapman Jr. Thomas B. Finan Jr. Patricia S. Florestano, PhD Nina Rodale Houghton The Honorable Steny H. Hoyer Orlan M. Johnson, Esq Leronia A. Josey, Esq Clifford M. Kendall Admiral Charles R. Larson, USN (Ret.) Bruce L. Marcus, Esq David H. Nevins The Hon. James C. Rosapepe The Hon. Joseph D. Tydings William T. Wood, Esq THE HONORABLE HAGNER R. MISTER Ex-officio J. ANDREW CANTER Student Regent

Chairmen Emeriti Francis B. Burch Jr. Joseph R. Hardiman

ART CREDIT

/ 2003

FAC U LT Y, STA F F & STUDENT LEADERS

ART CREDIT

ADMI N ISTR ATIVE OFFICERS

RACTIVITIES E S E AND A RGRANTS CH he University of Maryland reached a milestone number in extramural funding in FY02: $305.3 million, triple the amount of eight years ago. The research conducted on campus and the hundreds of projects funded from government, foundations, and the private sector demonstrate the Universityâ&#x20AC;&#x2122;s ever-increasing contribution to the life sciences and health care research fields.

Many researchers have contributed to this success. Here are the faculty for each school with the greatest competitively awarded research funding for FY02. For the School of Medicine, which conducts 85 percent of the University's total research activity, the leading seven clinical researchers and the leading three basic science researchers are listed. FY02

UNIVERSITY

MARYLAND

/ 2003

SCHOOL DENTAL

NAME Ronald Dubner, DDS, PhD

AREA OF INTEREST Persistent Pain

LAW

Diane Hoffmann, JD

Legal Issues in Health Care

MEDICINE

Myron Levine, MD

Vaccine Development

MEDICINE

J. Glenn Morris Jr, MD

Infectious Disease

MEDICINE

William Carpenter Jr, MD

Schizophrenia

MEDICINE

William Blattner, MD

AIDS

MEDICINE

Alan Shuldiner, MD

Genetics, Diabetes, Obesity

MEDICINE

Christopher Plowe, MD

Malaria

MEDICINE

Ligia Peralta, MD

Adolescent Pediatrics

MEDICINE

Barbara Hansen, PhD

Obesity

MEDICINE

Joe Lakowicz, PhD

Flourescence Spectroscopy

MEDICINE

Michael Shipley, PhD

Neurobiology

NURSING

Barbara Resnick, MS

Gerontology

PHARMACY

Ilene Zuckerman, PharmD

Drug Utilization

SOCIAL WORK

Catherine Born, PhD

Welfare Reform

Licensing Agreements Executed During FY02 he results of the research and discoveries of the UMB campus are translated into valuable intellectual property (IP) and, ultimately, commercial products that enhance the lives of people in Maryland and around the world. The University executed licensing agreements on the technologies described below:

I NVESTIGATOR SCHOOL DEPARTMENT

TITLE

Dean L. Mann, MD Medicine Pathology

Therapeutic Method and Composition Utilizing Antigen-Antibody Complexation and Presentation by Dendritic Cells

Patent

Company focused on cancer therapies. Using intellectual property to develop an assay to predict beneficial cancer therapies.

Robert Schwarz, PhD Medicine Psychiatry

NMDA antagonists

Patent

Developing, testing, and commercializing a lead compound that will be successful as a treatment for epilepsy.

Hamid Ghandehari, PhD Pharmacy Pharmaceutical Sciences

Targeted delivery of polyamine analogs for cancer chemotherapy

InterInstitutional Agreement

Agreement with the University of Mississippi for cancer-related research.

James E. Polli, PhD Pharmacy Pharmaceutical Sciences

Bile acid containing pro-drugs with enhanced bioavailability

Patent

Using intestinal bile acid transporter and bile acid-conjugated drugs to increase blood levels and effectiveness of those drugs.

J. Stephen Dumler, PhD Medicine Pathology

Cloned genes of Ehrlichia equi and the agent of human granulocytic ehrlichiosis

Patent

Technology used to grow antigens to develop an assay to detect various tick-transmitted diseases.

Bret A. Hassel, PhD Medicine UMCC

Cancer therapy or prevention pathway involving UBEIL, ISG15, UBP43

Patent

Research on cancer therapy using suppresor genes.

Enrico Bucci, MD, PhD Medicine Biochemistry

Controlled polymerization of hemoglobin

Patent

Technology related to creating a blood substitute.

Sharon C. Siegel, DDS Dental Restorative Dentistry

Cast mounting stabilizers; CaStixÂŽ

Patent; Trademark

Device to keep dental mold stable and properly aligned.

IP TYPE

INVENTION DESCRIPTION

UNIVERSITY MAGAZINE

MARYLAND

EDITORIAL BOARD Robert Barish, MD Howard Dickler, MD Russell DiGate, PhD Ronald Dubner, DDS, PhD Geoffrey Greif, DSW Alan Hornstein, JD James L. Hughes, MBA J. Glenn Morris Jr., MD, MPH & TM Lesley Perry, PhD, RN John Sauk, DDS, MS Norman Tinanoff, DDS, MS

EXECUTIVE EDITOR T. Sue Gladhill, MSW

MANAGING EDITOR Paul Drehoff

CONTRIBUTING EDITORS Eric Brosch Regina Lavette Davis, MA Danielle Sweeney

COPY EDITOR Sonia Elabd, MA

DESIGNER Tracy Boyd

University of Maryland magazine is published by the Office of External Affairs for alumni and friends of the dental, graduate, law, medical, nursing, pharmacy, and social work schools. Send reprint requests, address corrections, and letters to University of Maryland magazine, Office of External Affairs, University of Maryland, 515 W. Lombard St., Third Floor, Baltimore, MD 21201. Tel: 410-706-7820 Fax: 410-706-0651 General information about the University and its programs can be found at www.umaryland.edu.

Facilities Master Plan: Residence, Research, and Revitalization The University of Maryland’s new Fayette Street Student Residence, located in Baltimore at Fayette and Greene streets, will include a 300-occupant high-rise apartment building and six renovated historic buildings. The master plan also supports the revitalization of downtown Baltimore’s West Side and the creation of a Research Park west of Martin Luther King Jr. Boulevard.

UNIVERSITY OF MARYLAND Office of External Affairs 515 West Lombard Street Baltimore, Maryland 21201

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